TopicstoCover• NutritionClass
• ProteinandVitaminRequirements• PreandPost-SurgeryDiet
• FirstBiteClass(post-surgery)• Complicationsaftersurgery• StrategiesforSuccess
vDONOTLOSETHISPACKET!Itcontainsmanyanswerstoyourquestions!vPLEASEUSETHISPACKETASYOURGO-TONUTRITIONGUIDELINESvDONOTUSEGUIDELINESFOUNDONLINEORGIVENATTHEHOSPITALvEMAIL/CALLMEIFYOUSEEDISCREPANCIESORHAVEQUESTIONS
ExerciseisIMPORTANTFORWEIGHTLOSSStartbuildingaregularlyscheduledexerciseroutinenowbeforesurgery.ExercisewillhelptoMAINTAINWEIGHTLOSS aftersurgerybycreatingacaloriedeficit.YouwillneedbothDIETandEXERCISEtokeeptheweightoffaftersurgery!Exercisewillhelpovercomeweightlossstalls/plateaus• +5daysaweek:30minutes/daycardio
• Getyourheartrateup!Walking,cycling,elliptical,jogging,rowing• Consider“intervaltraining”=alternatinglow/easyandhigher/harderintensity
• +2daysaweekresistancetraining• Liftweightsoruseresistancebandstobuildmuscle• Buildingmusclewillimproveyourmetabolism=moreweightloss!• Needadequateproteintohelpmusclerepairandrecoverforgrowth
Power-systems.com VersaLoops
HealthyNutritionHabitsforLIFE!- LearntogroceryshopforYOUROWNFOOD!- Learntoprepare/packYOUROWNPORTIONEDMEALS/SNACKS.- Limitpackagefoods=Highinsalt/fat/sugar/calories- Dineoutless(restaurantsservelargerportions,andhavemorecalories!)- Learntoreadlabels
- Sugar<10gperserving- Fiber>3gperserving- %DailyValue:Followthe“5and20Rule”
- Nutrientsnear5%islowandnear20%ishigh- Lookatthelabelontheright- TotalFatis20%=highfatfood- SaturatedFatis25%=veryhigh- Sodiumis19%=highinsalt
- Don’tdrinkyourcalories!- Liquidsugar=Sweettea,soda,juices,coffeedrinks,smoothies,Gatorade- Forevery4gsugar=1tspsugar=1packetsugar
- Checkoutwww.calorieking.com fornutritioninformationonfoods
ArethesegoodBariatricfoodoptions?
Nutrition infofromwww.calorieking.com
LearnYourBasicFoodGroups• Protein:includeinallmeals/snacks
• Bestchoiceprotein:leanmeats,lowfatdairy,eggs,wholesoyfoods(tofu,soybeans/milk)• Nuts,seeds,beans,lentilscontainsmallamountsofprotein,notthebestsourceofprotein.
• Carbohydrates:includewithprotein,inallmeals/snacks• Grains,starches,fruitsandveggieshavecarbs• Bestchoiceandlowestincalories:“Non-starchy”veggies.Eatalotofthese!
• Broccoli,carrots,cauliflower,leafygreens,tomatoes,beets,squash,etc.• DONOTJUICEyourveggies!Liquidswillnotkeepyoufull!
• Starchveggies:peas,corn,potatoes,sweetpotatoes,beans,lentils• Grains:barley,oats,highfibercrackers,brownrice,quinoa• Wholefruitswithskinon,anykind.DONOTJUICEyourfruitordrinkfruitjuices.
• Avoideatingtoomuchdriedfruits.Followtheservingsizeandavoidaddedsugar(cranberries)
• Fat:Includesmallamountsoftheseinyourdiet• Bestchoice:oliveoil,avocadooil,nuts,seeds,avocado• Usetheseinverysmallamounts.Thesearehighinsaturatedfats
• Butter,coconutoil,cheese,heavycream,creamcheese,mayonnaise,saladdressing
BeAwareofYourBehaviorsRelatedtoFoodEmotionalEating- Eatingtodistractusfromnegativefeelings,snackingwhenyoufeelstressed/angry/sad/grieving/bored
MindlessEating- Eatingwhileengaginginotheractivities.Thisleadstoover-eating,eatingbeyondfullness- Ex:SnackingstraightoutofthecontainerwhilewatchingTV;continuingtograzewhensittingforalongtimeatthediningtable(easilyhappenswhenyou’reatarestaurant)
HabitualEating- Automaticdailyhabits,trainedyourselfintoanunhealthyroutine
- Ex:HavingStarbuckseverymorning/vendingmachinesnackseveryafternoon;pickingupfastfoodonthewayhome;alwayseating2nd portionsatdinner;snackinglatenighttomakeselfsleepy
Thesehabitscanreturnandmayleadtoweightregain- StronglyconsidertalkingtoapsychologisttodiscussCognitiveBehaviorTherapy/BehaviorModifications
WeightLossSurgerydoesnotfixthesehabitsrelatedtofood;itdoesnotfixthesebehaviors.Itisimportanttorecognize“thinking”vs.“feeling”hungryAskyourself:isitStomachhungerorHeadhunger??
Medical“FYIs”BeforeSurgery• Reviewyourchecklisttowhatelseyouneedtocomplete
• Youcanalsocallouroffice713-493-7700andaskforyourpatientnavigatortocheckonyourprogress• YourPatientNavigator:LaShan forDr.Scarborough,AmandaforDr.Yu,KarinaforDr.Mehta
• Getyourpre-surgerylabscompleted!!PleaseuseOURLABORDER• Pleaseusethelaborderwegaveyouinclinic.Weneedtoreviewyourbloodworkbeforesurgery• Priortogettinglabs:8hourfastingandstoptakingvitaminsforatleast24hours
• Ourofficewillcallyouwhenapprovedforsurgeryandwewillhelpyouto…• Scheduleyoursurgery,tellyouwhentostart2weekliquiddiet,andtoscheduleyourpre-opappointment.
• Pre-OpAppointmentatTLCClinic(~14daysbeforesurgery)• Meetwiththesurgeontodiscusssurgery.Youwillalsofindoutthehospitallocationforsurgery.• Bringlistofmedications/supplements,askquestionsforsurgeon(returntowork,exercise,fly/driveetc.)• DoyourDIABETICMEDSneedtobeadjustedwhileon2WeekPre-OpLiquidDiet??
• TalktoyourPCPorendocrinologist toadjustdiabeticmedswhileontheverylowcarbohydratepre-op liquiddiet!
• Pre-AdmissionTestingatsurgeryhospital(~7-10daysbeforesurgery)• Callyourhospitaltoschedulethisappointment
Medical“FYIs”BeforeSurgery
• STOPHERBALSUPPLEMENTS:2weeksbeforesurgery• St.John’sWort,BlackCohosh,MilkThistle,Melatonin,Turmeric,Ginseng,GingkoBiloba,Marijuana,etc.• BringthislisttoyourPre-Opappointmentforthesurgeontoreview• Thesecanincreasesthechancesofbleedingduringandaftersurgery
• WEARYOURCPAPNIGHTLYifyouhavesleepapnea!• Lowbloodoxygenlevelsmaypostponeyoursurgery
• STOPSMOKING!• Atleast1monthbeforesurgery.Andneveragainaftersurgery.• Riskforbloodclots(death),poorcirculationandpoorhealingaftersurgery,affectsbreathingunderanesthesiaduringsurgery,causesulcers/leaksinthestomachpouch
• Aimtoloseweightbeforesurgery,Donotgain!!• Losingsomeweight(>5%ofyourcurrentweight)beforesurgeryallowsthesurgeontomoreeasilyoperateonyou,therewillbelessbloodlossduringsurgery,andyouwillhaveafasterrecoveryandlesssoreness
Medical“FYIs”BeforeSurgery
• Duringoff-hours,oneofoursurgeonsisoncall.• Pleasecallouroffice713-493-7700 andouransweringservicewillpickup• Theywillpagethesurgeontoaddressyourmedicalconcerns
• Ifthisisamedicalemergency,pleasecall911• Becomefamiliarwithahospitalnearbyyourhomeincaseofemergencies.• It’shelpfulifthishospitalhasabariatriccenter/surgeononstafftoappropriatelytreatyou.
TakeVitaminsNOWBeforeSurgery• Getyourvitaminsbeforesurgery!• StarttakingbariatricvitaminsNOWto“vitaminload”
• Improvecurrentvitaminstatusandpreventdeficienciesfromoccurring/gettingworse• YoumaypurchaseatTLCfrontdeskoronline(TLC’se-storeordirectlywiththecompany’ssite)
• Startingtoday:takeminimaldoseofaBariatricMultivitamin(MV)andCalcium- Multivitamin:[1capsuleevery3days]or[1chewabledaily]- CalciumChews:1calcium(formen),2calcium(forwomen)- TakeanyothervitaminsthatwererecommendedbyyourPCPorbasedonlabs
• Forexample:additionalVitaminD,Iron,fishoil,etc.
• Youwilltakethesevitaminsuntilthedaybeforesurgery• Startnow,continuethrough2weekpre-opliquiddiet,thenstopdaybeforesurgery.• Gradually re-startBariatricMVandCalciumonDay3aftersurgery(astolerated)
• Startoffwith1MVforafew days…thenadd1calcium,graduallytotheFULLDOSE• FullDose:1multivit capsuleand3calciumchews,or2chewablemultivitand3calciumchews
TakeVitaminsBeforeSurgery– OnlyforRevisionPatients• YoualreadyhadVBG,verticalsleeve,RNYbypass
• TaketheALLofyourrequiredBARIATRICvitamins• BariatricMultivitaminswithIron,and1500mgCalcium“Citrate”• NO:gummies,patches,liquidmultivitamins
• StarttakingALLYOURVITAMINSNOW getbackontrackwithpropernutrition• Thiswillalsohelppreventdeficienciesfromgettingworseaftersurgery• Takeyourvitaminswithfoods,notonemptystomach• Donottakevitaminsalltogether,Spreadoutatleast2hoursapart.• KeepIronandCalciumseparate.• Donotdoubleuponvitaminsi.e.take2calciumatonetime=constipation,nausea,GIcramping
• TakeanyothervitaminsthatwererecommendedbyyourPCPorbasedonlabs• Forexample:additionalVitaminD,Iron,fishoil,etc.
• Youwilltakethesevitaminsuntilthedaybeforesurgery• Startnow,continuethrough2weekpre-opliquiddiet,thenstopdaybeforesurgery.• Gradually re-startBariatricMVandCalciumonDay3aftersurgery(astolerated)• Startoffwith1MVforafewdays…thenworkupto2MV,graduallytotheFULLDOSE
2weeksbeforesurgery:Pre-SurgeryLiquidDiet• Highprotein,lowcalorie,lowcarb/lowsugarliquids• Highprotein:proteinloadforimprovedhealingaftersurgery• Lowcalorie/sugar/carb:topromoteadditionalweightloss,helpstoshrinkfattyliver• Liquidsonly:cleanoutstomach/intestinestopreventinfectionduringsurgery• Mentalpreparationforpost-surgeryliquiddiet
• DrinkbothProteinShakesandClearliquids for2weeksbeforesurgery• RequiredforVerticalSleeve,GastricBypass,OverstitchandLoopDS/DuodenalSwitch• Endoscopic SleeveGastrectomy(ESG:only1weekliquiddiet)
• NOFOOD/ALCOHOL!!• Drink3-5Proteinshakeseachday• ALOT(unlimited)amountofClearliquids:Atleast64ozdaily• Topreventconstipation,kidneystonesandgoutduetohighproteindiet
Pre-OpLiquidDiet:ProteinShakesandClearLiquids
• Proteingoal60-150gramsdaily• 3-5shakesdaily• “Ready-to-drink”proteinshakesordrinks• Proteinpowders• Mixpowderwithice,water,0%-2%milk,unsweetsoymilk/nutmilk• DONOTUSEjuice/fruit/smoothies.Thisaddssugar,calories,bulk
• AlotofClearLiquids• Highproteindietscancauseconstipationandkidneystones• “See-through”liquids,anycolor• OKSugarsubstitutes.Nosugar,honey,maplesyrup,agave.• Nocaffeine(decafOK):caffeineisadiuretic/irritant(affectsdehydration,gastriculcers,acidreflux)• Nocarbonation(nosodas):cancausechestpainfromgaspressure
Pre-OpLiquidDiet:Strategies• DONOTDRINK
• SlimFast,Atkins,Ensure,Boost,Glucerna,CarnationInstantBreakfast,Herbalife,Shakeology,Advocare,NakedProteinSmoothies
• Notenoughprotein,andmaybetoohighinsugar/fat• AvoidJambaJuice,SmoothieKing,regularGatorade,fruit/veggiejuices,anysmoothies!
• Nausea• Switchtoclearliquidproteindrinksinsteadofmilkyshakes• SwitchtoWHEYISOLATE(Lactosefree) insteadofWHEYCONCENTRATE(containsLactose)• Eliminatewhey/milkprotein,tryPLANTBASEDPROTEINshakes
• Lookforblendsofpea,rice,nuts,beans,seeds• Lightheaded/Headaches,makesureyougetenough:
• +64ozwater,+60gramsprotein• Drinkregular(notlowsodium)broth• Mayadd1-2bottlesof12ozGatoradeG2togetsomecarbohydrates
• Feeling“hungry”• Addmoreprotein.Haveyoureached+60gramsprotein/day?• Eatsugarfree jello/popsicles.Thiscansatisfydesiretochew• IsitHEADhungerduetoboredom?Keepyourselfbusy!
TooLowInProtein– NotBariatricAppropriate
TooHighinCaloriesandSugar– NotBariatricAppropriate
AppropriatePre-OpProteinShakeOptions>20gramsprotein,<10gramssugar,<10gramsfat,<250caloriespershake
WheyConcentrate(containsmilkandlactose)
WheyIsolate(stillhasmilk,butislactosefree)
PlantBasedProtein
(nomilk andlactosefree)
HerearesomeProteinSupplementOptionsLookfor:>20gramsprotein,<10gramssugar,<10gramsfat,<250calories
• WheyConcentrate(containsmilkandlactose)• PremierProteinShake,MuscleMilkPROSeries,EASMyoplex,LeanBody byLaBrada,GNCLean25,CorePower ELITE
• WheyIsolate(containsmilk,butlactosefree)• PremierProtein“Clear”drinks,Isopure ZeroCarbProtein“Drink”,Unjury proteinpowder/shakes,GoldStandard100%Wheyproteinpowder,BariatricAdvantageproteinpowder,ICONICgrass-fedwheyproteinshakes,Dymatize Iso100powder
• PlantBased(Nomilk/lactose,DairyFree)• Orgain PlantBasedproteinpowder/shakes,VegaSport proteinpowder,PlantFusionproteinpowder,RawMealproteinpowder
PlantBasedProtein(dairyfree,vegan)Lookforproteinwithmultiplefoodsources,notjust1ingredient
1scoop170calories9gfiber21gproteinProteinsource:Pea,algae,millet,lentil,flax,chia
1scoop150calories3gfiber30gproteinProteinsource:Pea,pumpkinsee,sunflowerseed,alfalfa
1scoop100calories1gfiber20gproteinProteinsource:pea,hemp,gojiberry
1scoop120calories7gfiber20gproteinProteinsource:Pea,brownrice,amaranth,buckwheat,millet,quinoa,chia,adzukibeans,flax,garbanzobeans,lentils,pumpkinseeds,sesameseeds,sunflowerseeds
Non-Milky/CreamyHighProteinSupplements
PremierProteinDrink16oz,90calories20gprotein1gcarbsWheyproteinisolateSucralosewww.premierprotein.com
NectarProteinPowder1scoop=23gprotein25calories,0gsugarAcesulfame-K,SucraloseWheyproteinisolateManyfruity flavorswww.bariatricadvantage.com
IsopureZeroCarbProteinDrink20oz,160calories40gprotein0gcarbwww.isopurecompany.com
Isopure Infusions1scoop=20gprotein90calories,1gsugarSteviaWheyproteinisolate
AppropriatePre-OpClearLiquidOptions<50calories,<10gramssugarper8ounces,64ozormore!
HerearesomeClearLiquidOptionsLookfor<50calories,<5gramssugarper8oz
• MiO,CrystalLight,Powerade Zero,VitaminWaterZero,PropelFitnessWater,GatoradeG2/Zero,“hint”water,NestleSplashwater• Herbaltea(ex:chamomile,peppermint,ginger),decaffeinatedgreenteaandcoffee(sugarsubstitutesareOKtouse)• Sugarfreegelatinandpopsicles(nofruitbars)• RegularsodiumBroth(homemadeorstorebought,bonebroth,anyflavor)• Fruitinfusedwaters(addslicesofcucumber,orange,lemon,berries,etc.)• NOFRUITJUICE!!
VerticalSleeveGastrectomy(VSG)
Vertical(Laparoscopic)SleeveGastrectomy(VSGorLSG)
Advantages• Restrictstheamountoffoodthestomachcanhold• InducesrapidandsignificantweightlossthatcomparativestudiesfindsimilartothatoftheRoux-en-Ygastricbypass.Weightlossof>50%for3-5+yeardata,andweightlosscomparabletothatofthebypasswithmaintenanceof>50%• Requiresnoforeignobjects(band),andnobypassorre-routingofthefoodstream(RYGB)• Involvesarelativelyshorthospitalstay• Causesfavorablechangesinguthormonesthatsuppresshunger,reduceappetiteandimprovesatiety
Disadvantages• Isanon-reversibleprocedure• Hasthepotentialforlong-termvitamindeficiencies• Hasahigherearlycomplicationratethantheband
EndoscopicSleeveGastrectomy(ESG)
• 1weekpre-opliquiddiet(not2)• Daysurgery(willgohomesameday)• Followsamevitaminanddietguidelines
Roux-en-YGastricBypass(RYGB)
Rouxen YGastricBypass(RYGB)
Advantages• Producessignificantlong-termweightloss(60to80%excessweightloss)• Restrictstheamountoffoodthatcanbeconsumed• Mayleadtoconditionsthatincreaseenergyexpenditure• Producesfavorablechangesinguthormonesthatreduceappetiteandenhancesatiety• Typicalmaintenanceof>50%excessweightlossDisadvantages• IstechnicallyamorecomplexoperationthanthebandorLSGandpotentiallycouldresultingreatercomplicationrates• Canleadtolong-termvitamin/mineraldeficienciesparticularlydeficitsinvitaminB12,iron,calcium,andfolate• Requiresadherencetodietaryrecommendations,life-longvitamin/mineralsupplementation,andfollow-upcompliance
LoopDuodenalSwitchSADI-S:SingleAnastomosisDuodeno-Ileal BypasswithSleeve
DuodenalSwitchAdvantages• ResultsingreaterweightlossthanRYGB,LSG,orband,i.e.60– 70%percentexcessweightlossorgreater,at5yearfollowup• Allowspatientstoeventuallyeatnear“normal”meals• Reducestheabsorptionoffatby70percentormore• Causesfavorablechangesinguthormonestoreduceappetiteandimprovesatiety• IsthemosteffectiveagainstdiabetescomparedtoRYGB,LSG,andbandDisadvantages• Hashighercomplicationratesandriskformortalitythantheband,LSG,andRYGB• Hasagreaterpotentialtocauseproteindeficienciesandlong-termdeficienciesinanumberofvitaminandminerals,i.e.iron,calcium,zinc,fat-solublevitaminssuchasvitaminD• Compliancewithfollow-upvisitsandcareandstrictadherencetodietaryandvitaminsupplementationguidelinesarecriticaltoavoidingseriouscomplicationsfromproteinandcertainvitamindeficiencies
AfterSurgeryVitaminsRequirements• Gradually re-starttakingBariatricMVandCalciumonPost-OpDay3(FullLiquidPhase)
• Take1multivitaminforafewdays,thenworkupto2,thegraduallyworkuptothefulldose (astolerated)
• Donottakevitaminsonanemptystomach.Takewithfood/proteinshake.• Spreadoutallyourvitamins;Donottakethemalltogether!!Keepdosesatleast2hoursapart
• Maycausenausea,stomachaches,burpsandpouchfullnessiftakenallatonce• Maycausemal-absorption ofnutrients
• IronandCalciumneedtobekeptseparate,atleast2hours• Avoidusingcaffeine(coffee,icetea,green/blacktea)anddairy(proteinshakes,yogurt,milk)withIron• Phytatesblockabsorptionofiron,calciumandzinc(grains,beans,nuts,potatoes)
• Consider soakingand“sprouting”thesefoodstobreakdownphyticacid
• Post-surgery,considerchangingyourvitaminsandmedications(askyourDr)tothisform:• Chewable• Crushandcuttablet(smallsizetofitthroughadrinkingstraw)• Approvedcapsule(designedforweightlosssurgery)oropenupacapsule(askyourdoctor!)
• Thesearedesignedtodissolvequicklyuponcontactwithheatandmoisture• NOTRECOMMENDED
• Vitaminpatches,liquidmultivitamins (Tespo),pre-natal,childrenvitamins,over-the-counterhardtablets• NOGUMMIESORGUMBALLS(toomuchsugar,poorquality,lownutrients)
Bypass/Sleeve/DSVitaminsRequirements• Allvitaminsthatyouarerequiredtotake,areforMAINTENANCE(tostayatnormallevels)
• Thesebariatricvitaminsarenotenoughtocorrectavitamindeficiency• Ifyouarelowinothervitamins,youwillneedtotakeadditionalamountsuntilyoure-drawlabsat3monthspost-surgery• Ex:LowVitaminD?YouwillneedtotakeextraVitaminDuntilwere-checkyourlevels• Anemic?YouwillneedtotakeextraIroninadditiontowhatisprovidedalreadyinyourMV
• VitaminD/FishOilwillneedtobeliquid/chewableforatleast3months• OurTLCfrontdeskofferschewable VitaminDandahighpotencyliquid fishoil
• Don’tlikeBariatricAdvantage?CelebrateVitamins.com isanotherappropriatebrandtochoose• …orCALLMEandI’llhelpyoufindanappropriatealternative• Notall“bariatric”advertisedvitaminsaregoodqualityandmaynotcontaineverythingyouneed!• Refertonextslidetoseewhatyoushouldlookforinanappropriate“BariatricMultivitamin”• BecarefulwhenyoubuyvitaminsatGNC,VitaminShoppe,Walmart,CVS,etc.
• Youmayendupbuyingthewrongitems!• Stillunsureifyouboughtthecorrectone?Takeapictureandemailme!linlin@tlcsurgery.com
Bypass/Sleeve/LoopDSVitaminRequirements• 3.Calcium“Citrate”(notcarbonate)
• Citrateisless likelytoformcalciumstones• Bypass/Sleeve:1,500mg/day(500mgx3)• LoopDS:+2000mg/day(500mgx4)• Separateeachdose
• 500mgateachdose• Takewithfood• KeepCalciumseparatefromIron• Take2hoursapartfromIron(orMVwithIron)
• Calciumfromfoodcountstoo!
• 4.VitaminD3• 3,000to5,000IUdaily
• 5.Iron• Bypass/LoopDS:40-65mgperday• Sleeve
• 40-65mgdaymenstruating/anemic• 0-18mgfornon-anemicmen/women,post-hysterectomy-menopausal,non-menstruating
• Takewithfood• Maycauseconstipation/teeth staining• Avoidtakewithcaffeine/dairy/calcium
• 1.CompleteMultivitaminEVERYDAY,FOREVER!• Preferably“Bariatric”type
• +12mgB1(Thiamin)• +800mcgfolicacid• 5,000-10,000IUVitaminA• +15mgVitaminE• 90-300mcgVitaminK• 8-22mgZinc(>100%)• 1-2mgCopper(>100%)
• 1mgCuforevery8-15mgZn• Selenium,Chromium
• Youmayneedtotake2-3pillstoprovide200%• NOGUMMIES!!!• Chewable/approvedcapsulefor1st 3months
• 2.B12• OverthecounterSublingual(350-500mcg/day)• RxNascobalNasalspray(500mcg/week)• RxIntramuscularinjection(1,000mcg/month)
GastricBypassVitamins• UltraSolowithIron
• Swallow1capsule/day- OR-• AdvancedMultiEA
• Chew2tablets/day• Bothoptionsinclude
• completemultivitaminandmineral• 25mgB1• 500mcgB12• 3000IUVitaminD• 45mgIron
• StillneedCalciumChewyBites• 1500mgCalciumCitrate• 500mgx3daily• Keepcalcium2hoursapartfromyourmultivitamin
DuodenalSwitch/LoopDSVitamins• UltraSolowithIron
• Swallow1capsule/day- OR-• AdvancedMultiEA
• Chew2tablets/day• Bothoptionsinclude
• completemultivitaminandmineral• 25mgB1• 500mcgB12• 3000IUVitaminD• 45mgIron• 10,000IUVitaminA• 20mgVitaminE• 120mcgVitaminK
• StillneedCalciumChewyBites• 2000-2500mgCalciumCitrate• 500mgx4daily• Keepcalcium2hoursapartfromyourmultivitamin
SleeveVitaminsMenstruatingWomenAnemicMenandWomen
• UltraSolowithIron• Swallow1capsule/day
- OR-• AdvancedMultiEA
• Chew2tablets/day• Bothoptionsinclude
• completemultivitaminandmineral• 25mgB1• 500mcgB12• 3000IUVitaminD• 45mgIron
• StillneedCalciumChewyBites• 1500mgCalciumCitrate• 500mgx3daily• Keepcalcium2hoursapartfromyourmultivitamin
SleeveVitaminsNonAnemicMenNonAnemicWomenwhoare:Post-Hysterectomy,Menopausal
• “BariatricAdvantage”UltraSoloWITHOUTIron• Swallow1capsule/day
- OR-
• “CelebrateVitamins”MVSoftChews• Chew2squares/day• Doesnotcontainiron
• Bothoptionsinclude• completeMultivitamin• 500-1000mcgB12• 3000IUVitaminD• NoIron
• StillneedCalciumChewyBites• 1500mgCalciumCitrate• 500mgx3daily• Keepcalcium2hoursapartfromyourmultivitamin
Doyouknowwhichvitaminsyouneed?SurgeryType Multivitamin:ChooseOne AndalsogetabagofCalcium
GastricBypassUltra Solo with Iron x1- or-AdvancedMultiEAx2
Calcium ChewyBitesx3
DuodenalSwitch
Ultra Solo with Iron x1- or-AdvancedMultiEAx2
Calcium ChewyBitesx4-5
Sleeve needing Iron- Menstruating Female- Anemic Male- Anemic Female
Ultra Solo with Iron x1- or-AdvancedMultiEAx2
Calcium ChewyBitesx3
Sleevedonot need Iron- Non-AnemicMale- Post-Hysterectomy/Post-Menopausal/Non-AnemicFemale
Ultra Solo WITHOUTIronx1- or-MultivitaminSoftChewx2
Calcium ChewyBitesx3
SampleVitaminScheduleChooseeitherOptionA(capsule),OptionB(chewable)orOptionC(softchew)RemembertokeepIronandCalciumatleast2hoursaparttopreventmalabsorption.Spreadoutyourvitamins.Takewithfoodorproteinshaketopreventstomachache.Donotdoubleupondose.Takeoneatatime.MaytakeVitaminD,fishoil,Biotin,probiotics,etc withMVorCalcium.
Options Breakfast AMSnack Lunch PMSnack Dinner Bedtime
OptionACapsule
Ultra Solo(withorwithout Iron)1capsule
CalciumChewyBite1x
CalciumChewyBite1x
CalciumChewyBite1x
OptionBChewableTablet
AdvancedMultiEA1chewabletablet
CalciumChewyBite1x
AdvancedMultiEA1chewabletablet
CalciumChewyBite1x
CalciumChewyBite1x
OptionCSoftChew
Celebrate1MVSoftChew
CalciumChewyBite1x
Celebrate1MVSoftChew
CalciumChewyBite1x
CalciumChewyBite1x
“UltraSolowithIron”ONEADAYMULTIVITAMINAppropriate forDuodenalSwitch,GastricBypass,Sleeve(anemic,menstruating)KeyHighlights:- 1capsuleperday(Stillneed3CalciumCitrateChewyBitestoget1500mgCalcium)- 3000IUVitaminD- 25mgB1(Thiamin)- 800mcgFolate- 500mcgB12- 45mgIron
AdvancedMultiEAChewableTablets(containsiron)- Appropriate forDS,GastricBypass,Sleeve
(anemic,menstruating)- 2ChewableTablets/Daily- 3000IUVitaminD- 1000mcgB12- 12.5mgB1- 45mgIron- StillneedtogetseparateCalcium
“UltraSolowithoutIron”ONEADAYMULTIVITAMINAppropriate forOnlySleeve(non-anemicmen,non-menstruating andnonanemicwomen)- 1capsuleperday(Stillneed3CalciumCitrateChewyBitestoget1500mgCalcium)- 3000IUVitaminD- 25mgB1(Thiamin)- 800mcgFolate- 500mcgB12
CelebrateMVSoftChews• AppropriateforOnlySleeveNon-AnemicMenPost-Hysterectomy,Post-MenopausalandNon-AnemicWomen• 2softchewsdaily• 3000IUVitaminD• 12mgB1• 500mcgB12• StillneedseparateCalcium
CalciumCitrate ChewyBitesGastricBypassandSleeve:Take3chewybitesdailyDuodenalSwitch:Take4chewybitesdaily
CheckoutourE-Storeatwww.tlcsurgery.comclickhere!
• Foradirectlinktoour recommendedvitamins,gotoourwebsite:www.tlcsurgery.com
• Clickontheyellowbox“VisitOurVitaminStore”Thiswillbring toourE-Storepage
• SelectBariatricAdvantageorCelebrateVitaminsforTLC’srecommendedweightlosssurgeryvitamins
• Youmayalsogodirectlytoeachcompany’swebsite• www.BariatricAdvantage.com
• Enterourvalidationcode:TLC• SignupforAutoRefillOrders,with10%off firstorder
• www.CelebrateVitamins.com• SignupforAutoShipOrders,with10%offallorders
BariatricAdvantage:AdditionalSupplementsifneeded• VitaminD3ChewableGels
• 1gel=10,000IU.Take1geldaily,or1geleveryotherdaytoget5,000IU
• Iron– lessconstipatingthanoverthecounter“FerrousSulfate”• 29mgChewableIronPassionFruit:CarbonylIronandFerrousFumarate• 60mgChewableIronLemonLime:CarbonylIron
• BVitamins• B50Complexcapsule,2capsulesdaily• B121000mcg,1dissolvabletablet• B1Thiamin100mg,1capsule
• Non-chewableCalciumCitrateTablets:2tablets=500mg,6tablets/day=1500mg• ProteinPowderAlternatives
• HighProteinVegetableSoup:Savoryalternativeforproteinpowders• Dairyfree,madewithpeaprotein,1serving=20gprotein
• NectarUnflavored:Mixintofoods,wheyproteinisolate,1scoop=10gprotein• NectarProtein:Manyflavors,wheyproteinisolate,1scoop=23gprotein
• Probiotic,chewable
OtherBrands:VitaminsandSupplementsifneeded• BariMelts D31tablet=5,000IU;www.barimelts.com
• Vitron Ctablet65mgCarbonylIron;www.vitronC.com
• NordicNaturalsOmega3FishOil;TLCClinic,WholeFoods,Sprouts,VitaminShoppe,amazon.com• ProOmega 2000-D2softgels=2000mgOmega3(1125mgEPA,875mgDHA)• ProOmega-DXtra1tsp=2925mgOmega3(1950mgEPA,975mgDHA)
• Barlean’s liquid“FishOilOmegaSwirl”2tsp=720mgOmega3• AvailableatmostHEBgrocerystores;www.barleans.com;Amazon
• Wellesse LiquidCalcium3Tbs=1500mgCalciumCitrate;Walgreens,www.vitacost.com• CitraCalCalciumCitratePetites
• 6-8“petite”tablets=1400-1600mgCalciumCitrate
• NutritionDirect,BariActivwww.nascobal.com• Bariatricvitaminsthatarecoveredbyinsurance• OralMultvitamins,calcium,andIron.B12nasalspray
• FitformeWLSOptimumwww.fitforme.com• Bariatricvitamins,onlineonly
• Feosol Ironsupplementswww.feosol.com;availableatCVS,Walgreens,Walmart,Target,amazon.com• Original:FerrousSulfate,1tablet65mg• Complete:gentle,lessconstipating,1tablet28mg
2MonthPost-SurgeryDietProgression• Purpose:Graduallyintroducedifferenttexturesuntilbacktoeatingsolidfood• Youarehealingfromanewswollenstomach• Re-learninghowtoeat:cuttingfoodintosmallpieces,chewingintoamush,slowingdowntoeat.• Yourtastebudsmaychangesouseseasoningscarefully• DONOTSELFADVANCEDIET/DONOTRUSHTHEDIET
• Causesunnecessarypainandleaksinyourstapleline• Examples:Clearliquidphase– Patientatefajitasandkielbasasausage.Endedbackinthehospital.
Fullliquidphase– Patientatesteakbecausehewascookingforhisfamily.Hiswifecalled911becausepatientthoughthewashavingaheartattack(chestpain).
• Day1- 2:Clearliquids– focusonhydration• Day3- 14/Week1-2:Fullliquids– startproteinshakesandsoups,startvitamins• Day15/Week3- 4:Pureed– “baby-food”texture• Week5– 6:Soft,choppedmeatsandcookedveggies• Week7- 8:ChoppedSolids(MaintenanceStage)
• Duringthese2months:AVOIDRESTAURANTS (largeportions,highsugar,highcalorie=vomiting/diarrhea)
AVOIDRESTAURANTSduringyour2monthpost-surgerydiet progression!Largeportions,highfat/highsugarfoods=DumpingSyndrome
*4gramsofsugar=1tsp=1packetofsugar*
2weekPre-SurgeryLiquid Diet
SURGERYDAY!
Post-OpDay1Clearliquids
Day 2ClearLiquids
3FullLiquidsBeginVitaminsAstolerated
4 5 6 7
8 9 10 11 12 13 14
Day15Week3-4Pureed
16 17 18 19 20 21
22 23 24 25 26 27 28
Week5-6ChoppedSoftSolids
Week7-8ChoppedSolids
DietCalendarFill inyourowndatesoyoucanseewhenyoushouldprogresstothenextdietphase
Learnwhentomoveontothenextdietphase.
Protein shakesandclearliquids, andminimaldosevitamins
Day3-14:Protein shakes,soups,yogurtandpudding, beginvitamins
Day15-28:mashedeggs,fish,beans;oatmeal,applesauce
2weeksofchopped, softmeats,cookedveggies,peeledfruits
2weeksofdifferent kindsofchoppedmeats,chopped rawveggies,fruits withpeel
Day1-2:ClearLiquidsONLY• Mainpurpose:REHYDRATION!• Post-SurgeryDay1(thedayaftersurgery):Startslowandtakesmallsipsalldaylong
• Aimforatleast2oz every15minutes,1cupperhour• Gohomeandresumeclearliquids(sameas“Pre-SurgeryClearLiquids”)
• Post-SurgeryDay2:Continueclearliquidsathome• Clear/See-through,<50caloriesand<10gramssugar
• NoCaffeine.OKdecafcoffee/tea,herbaltea.OKsugarsubstitutes,Nocreamer• Caffeine:diuretic,irritatingtoulcers,maycauseacidreflux,blocksIronabsorption
• Nocarbonation/nostraws• Chestpainfromswallowingtoomuchair/trappedgas
• Nomilkythickproteinshakes/vitamins/solidfood!!!• Forexample:
• Monday:SurgeryDay• Tuesday:Post-OpDay1(Day1ofclearliquids),gohome• Wednesday:Post-OpDay2(Day2ofclearliquids)
• Verticalsleeve,gastricbypass,duodenalswitch:plantostayovernightinhospital(gohomeDay1)• ESG:youshouldbedischargedhomesamedayassurgeryday
• Aimfor+48-64ozlowcaloriefluidsperday.Sameclearliquidsasthe“pre-surgeryclearliquids”• NOLIMITTOHOWMUCHYOUCANDRINK.Ifyoucandrinkmore,thenpleasedoso!!!
Day1-2:ClearLiquidsONLY(continued)Lowenergy,headache,lightheaded,difficultyconcentrating?• Keepdrinkingplentyoffluids.Youcouldbedehydrated!• SipALLDAYLONG.Useacoughsyrup/medicinecuptopaceyourself.
• DrinkATLEAST2oz (ormore!)every15minutes.DrinkMOREifyoucan!• Modifytheflavor.Flavoredbeveragesmaybeeasiertodrink• Modifythetemperature:hotteaoricecolddrinksmaybeeasiertodrink• Useaspoonorsuckonacupofcrushedicechips/sugarfreepopsicles• Eatingsugar-freeJello cansatisfythedesiretochew• DrinkG2,regularsodiumbroth,clearliquidprotein“drinks”forenergy• Providessomecarbohydrate,electrolytesandprotein
Day3-14:Full(Thickened/Milky/Opaque)Liquids• BeginBariatricVitaminsgradually
• Take1forafewdays,thenworkupto2,etc…
• TOPPRIORITY:STAYHYDRATED!48-64ozdaily.• ContinuetodrinkfluidsALLDAYLONG• OKtohaveDecafcoffeeandteawithmilkorfatfreecreamer,andsugarsubstitute
• Proteingoal:drinkatleast+40-60grams/day• Resumedrinkingproteinshakes• Eachshake:↑20gramsprotein,↓10gramssugar,↓250calories• Ready-to-Drinkproteinshakes:Premier,LaBrada LeanBody,MuscleMilk,etc.• ProteinPowders:Dymatize 100%Wheypowder,etc.
• Blendedwithice,water,0-2%milk orunsweetenedsoy/nutmilk• Donotaddfruit,veggiesorjuice,donotmakesmoothies
• Addingfruit/rawveggiesmaycausestomachcrampingduetofiberandsugar• NOSMOOTHIES!NOGREENJUICES!=diarrhea• Tryhighproteinmilks:Fairlife UltraFilteredMilk,HEBMootopia,SilkNutProteinMilk
Day3-14:Full/ThickenedLiquids(continued)• ¼to½cuppermeal,5-6xday(orless)• Smooth,ThickandLowFatSoups(NOTBROTH!)
• Moveonfrombroth.Drinkingthickersoupswillbenourishingandsatisfying!• Lookfor:Lessthan10gsugarperserving,Lessthan5%totalfat• Smoothsoupsinabox(LookforImagine,PacificBrandorTraderJoe’sboxsoups_• Lowfatcreamsoups:Campbell’s98%FATFREEcreamsoups.Strainoutanybitsandchunks• LowSodiumV8VegetableJuiceisalowersugarthantomatosoup• NOHEAVYCREAMSOUPS(bisque,chowders).TOOHIGHINFAT=dumpingsyndrome!
• HomemadepureedCOOKEDveggiesoups,strained.NOFRUITS/MEATS• Pureedcauliflower/butternutsquash/pea,etc.Seasoningsarefine touse!• AddwholemilkorplainGreekyogurtforproteinNOHEAVYCREAM!
• Smooth Yogurt/SugarFreePudding• Nofruitpieces.Chooseflavorslikevanilla,lemon,etc.• ChoosepreferablyGreekstyleforextraprotein:Oikos TripleZeroGreekyogurt,YoplaitGreek100• Checkthelabel!!Keepsugarlessthan10grams
Full(Thickened/Milky)LiquidOptions
HowtomakeFlavorfulProteinShakes• OKtomixin:• 0-2%milk,unsweetsoymilk,unsweetnutmilks• Spicesandextracts,unsweetcocoapowder• PB2(lowfatpeanutbutterpowder),sugarfreesyrup,decafcoffeecrystals
• NOTOKtomixin(addsextracalories,fatandsugar)• Blendedfruits/veggiestomakesmoothies,juices• Nutbutter,avocado
UnflavoredProteinPowdersMixintofoods/liquidstoaddaboostofprotein
Beginusingsmallamount(1tsp)andgraduallyincrease(1Tbs,½scoop)asyourfood intakeincreases
Unjury.comTLCClinic21gprotein90calories(recipesonline!)WheyIsolate
BeneproteinNestleNutritionStore.comWalgreens1scoop(1.5Tbs)6gprotein25caloriesWheyIsolate
IsopureGNCVitaminShoppe25gprotein100caloriesWheyIsolate
EggWhiteProteinJayRobb.comHEB,Sprouts25gprotein115calories
NectarUnflavoredBariatricAdvantage.com20gprotein80caloriesWheyIsolate
*Donotmixproteinpowder intoboilingorveryhotliquids.Thiswillcauseproteinpowdertoclump.Letliquidcooldownslightly,thenmixinproteinpowder
FullLiquidPhaseRecipeHighProteinCreamySoup
Makes~2servings• 1canof Campbell’s98%FATFREEcreamsoups(mushroom,chicken,celery,etc.)• ½cuplowfatmilk• 1scoopUnflavoredproteinpowderHowtomakeit:1. Heatsoupuntilcookedthroughinmicrowaveorstovetop2. Removesoupfromheatandallowtocoolslightlysothatitisnot
boiling/scaldinghot(Donotmixproteinpowderintoveryhotliquids,thiswillcauseproteinpowdertoclump)
3. Dissolve1scoopproteinpowderinto½cupmilk,thenstirproteinliquidintosoup
4. Poursoupthroughstrainertoremoveanybitsandpieces5. Serveandenjoy!
SampleFullLiquidDietBreakfast 4oz (1/2cup)proteinshake(10gprotein)
1st Snack ¼to½cupGreekstyle yogurt (11gprotein)
2nd Snack 4oz (1/2cup)proteinshake(10gprotein)
Lunch ¼to ½cupsmooth lentilsoup+1TbsGreekyogurt (2.5g+1.5gprotein)
Snack 4ozprotein shake(10gprotein)
Dinner ¼ to½cupsmoothpeasoup (9gprotein)
Snack 4ozproteinshake(10gprotein)
TotalProtein 64gprotein
Day15:Week3-4:Pureed/Mashed• Youshouldbetakingallyourvitaminsnow• Continuedrinkingplentyoffluids (+64oz)andmeetyourproteingoal(+40-60grams)• Fromthispointon,donoteatanddrinktogether ever
• Wait15minutesafterdrinking toeat/Wait30minutesaftereatingtodrink• ¼to¾cupportions permeal.Startwith1-2Tbs.Aimfor<5-6smallmeals,every3-4hours• ItisOKtoseasonyour food!Salt/pepper/herbs/spices, mustard/mayo,sugarsubstitutes,etc.• ApplesauceTexturebeforeyoueat:MashedverywellwithforkorBlendinamini-foodprocessor
• EatProteinFoodsFirst!!Meats,eggsanddairyproducts• Mashedsoftscrambledeggs(tryitwithhotsauce,ketchup,pinchofshreddedcheese)• Lowfatcottage/ricottacheese (addmashedpeachesorsugarfreejam)• Mashed“white”fish:flounder, trout,tilapia,etc.• Mashedsmooth tuna/salmon/cannedchickenwithbitofmayo.NOchunkyingredients: relish, celery,hardboiled eggs• Trytoavoidbabyfoodmeals:Considermakingyourown“babyfood”
• Finelygroundcookedleanbeef/pork/chicken/turkey/seafoodmincedwithwithcookedbroccoli,sweetpotatowithbroth
• Fiberfoods:• Mashedbeans(norestaurantrefriedbeans);hummus;mashedavocado• Unsweetapplesauce,mashedfruits:bananas,“cannedinfruit juice”peaches,pears• Mashedcooked veggies:mashedpotatoes,sweetpotatoes,carrots,cauliflower,broccoli,etc.
• Babyfood fruit/vegOKifonlyblended withwater• MicrowavePLAINoatmeal,PLAINgrits, creamofwheat,Malt-O-Mealandseasonityourself!
Pureed/MashedAppropriateFoods
PortablePureedFoodIdeastotakeonthego!
PureedFoodOptions• Protein:Meats,eggs,dairy,soy• Mashedwhitefish(flounder,trout,etc.),mashedcannedtuna/salmon/chickenwithasmallamountofmayo,blenderized beef/chicken/porkwithsoftcookedveggies• Mashedsoftscrambledeggs• LowsugarGreekyogurt,lowfatcottagecheesemixedwithpureedfruits(applesauce,pureedpeaches,mashedbananas)• Ricottacheesewithmarinarasauceandasprinkleofparmesancheese• Mashedsilkentofuseasonedwithsoysauceandsmallamountofsesameoil• Avoidbabyfood“meals”=poorqualityprotein
• HighFiberFoods:veggies,fruits,beans,nuts• Mashedcarrots,cauliflower,broccoli,avocado,babyfoodveggies• Applesauce,mashedbananas,peaches,pears,strawberries/kiwis,mango,babyfoodfruits• Homemademashedbeans,cannedfatfreerefriedbeans,mashedlentils,hummus• Plaininstant:oatmeal,grits,creamofwheat,maltomeal.Addyourownsugarsubstitutes• 1-2Tbs smoothnutbutter
PureedPhaseRecipeCheesyCauliflowerCasseroleMakesalargeportion tosharewithfamilyandfriends• 4cupssteamedtoforktendercauliflower• 3 Tbsbutter• ¼cupall-purpose flour• ½tspdrymustardpowder• Saltandpepper toseason• 3cupmilk• 2cupslowfatcheddarcheese
Directions• Setasidesteamedcauliflower• Melt3Tbsbutterandstirinflourandseasonings• Addmilkandcookuntilthickened, thenstirinshreddedcheeseuntilmelted• Pourovercauliflower.Atthisphase,yournon-bariatricfamilyandfriendscanenjoy this.• Add¼cupportion intofoodprocessorandblenduntilsmooth.
RecipefromTheWorldAccordingToEggFace.blogspot.com
PureedPhaseRecipeGarlicChickenSaladMakes4servings.Servingsize1/4cup
• 6oz.cannedchicken,drained,reserve1Tbsofbrothfromcan
• 1tspoliveoil• 1Tbsapplecidervinegar
• ½tsponionpowder• 1tspgarlicpowder
• ¼tspdriedbasil
• PinchsaltandpeppertotasteDirections
• Placeallingredientsinblenderandpureedfor30seconds• Usingrubberspatula,scrapedownsidesofbowl
• Addbrothfromcanifathinnerconsistencyifdesiredandpureedforanother15seconds
RecipebyChefDaveFouts
PureedPhaseRecipeCrabLouieMakes3servings.Servingsize1/4cup
• 6ozcookedcrab
• 1tsplightmayonnaise• ½tsplemonjuice
• 1Tbschilisauce• 1dashWorcestershiresauce
• ½tsponionpowder
• ¼tspsweetpicklerelish• Pinchsaltandpepper
Directions• Placeallingredientsinblenderandpureedfor30seconds
• Usingrubberspatula,scrapedownsidesofbowlandpureed20secondsoruntilsmooth
RecipebyChefDaveFouts
PureedPhaseRecipePintoBeansandCheeseFreshStartBariatricCookbookbySarahKentMSRDMakes4servings• 115ozcanofpintobeans,drainedandrinsed• 1Tbs freshlysqueezelimejuice• 1tsptacoseasoning(lowsodiumoptional)• ¼cupshreddedcheese(2%Cheddar,MexicanBlend,pepperJack,etc)
Directions:1. Insmallpotovermedium-lowheat,heatbeans
thoroughly.Turnoffheatandthenaddlimejuiceandtacoseasoning.Stirtocombine.
2. Toachievepureedconsistency,useablenderorimmersionblendersticktopureedbeans,ormashverywellwithpotatomasher
3. Beforeserving,topbeanswithcheese andstirtomelt
IndianCurryChickenPureeRecipeadaptedfromGastricSleeveCookbook:TheCompleteBariatricRecipesGuideandCookbookforYouAfterWeightLossSurgeryBy:SarahMcCabe
Ingredients8ozcookedchickenbreast/thigh(skinless,shredded– leftoverRotisseriechickenworkstoo!)1cupchickenbroth2TbsWholeMilk/LowFatplainGreekyogurt½cup0-2%milk½cupchoppedtomatoes(fromacan)½Tbs currypowder1clovegarlicPinchofsalt
Directions:1. Heatupbroth2. Inafoodprocessor,addcookedchicken,yogurt,milk,tomatoes,garlic,currypowder,saltandonly
halfofchickenbroth3. Pulseuntilfinelymincedandaddremainingbroth.Blenduntilsmooth(removeanyvisiblelargepieces
offood)
SamplePureedDiet
Breakfast 1 largesoft scrambledeggor2eggwhites(6gprotein)
Snack 1/4c.lowfatsmallcurdcottagecheesemixedwith2Tbsunsweetenedapplesauce,sprinkledwithcinnamon(7g protein)
Lunch 2ozskinless chicken with¼cupwell-cookedbroccoli,pureed togetherwith1-2Tbschickenbroth(14gprotein)
Snack 4- 6oz.protein shake(10-16gprotein)
Dinner 2ozlemonherb flounder, mashedwith¼cupmashedsweetpotato(14gprotein)
Snack 4- 6oz.proteinshake(10-16gprotein)
Total Protein 61-73gprotein
Week5-6:Soft“Chopped”Solids• Continuedrinking lotsofwater,aimfor+40-60gprotein, takevitaminsdaily• Eat~½to¾cuppermeal,5-6smallmealsevery3hours• Donoteatanddrink together.Noliquidswithsolids.• Soft/easytochew,shredorbreakapartintosmallchunkswithfork• Fromthispointon,allyourfoodsneedtobechopped into“tipoffinger”size
• Foodschopped intosmallpiecesareeasiertochew!!• Eatproteinfirst.Eatproteinwithallmeals/snacks(Thiscanprevent“dumping”)• Proteinfoods
• Shreddedskinlessdarkmeatchicken, turkeymeatloaf,tenderpotroast,bakedfish/sashimi (norice)• Avoiddrychickenbreast,grisly/chewywell-donesteaks,dryporkchops
• Eggsanystyle(Hardboiled eggsareOK)• Stringcheese,Babybelcheese,lowfatcheeseslices• Chopped thindeliturkey,ham,chicken, roastbeef• “Soft”Nuts:walnuts,pecans,cashews,peanuts, slicedalmonds
• Non-ProteinFoods• High fibercrackers,branflakes(+3gramsfiberperserving).NOBREAD/PASTA/RICE/TORTILLAS!• Beans,quinoa,peeledchoppedsmall/sweetpotatoes• Chopped, CookedFork-TenderVegetables
• Choppedsoftbroccoli,carrots,cauliflower,zucchini,peelpotatoes,etc.• Finelychoppedcookedstringyveggies(greenbeans,spinach)• Noraw,nosaladsyet:difficulttodigest,willcausevomiting/diarrhea
• Chopped PeeledFruit• Citrussegments(remove“membrane”),cannedfruitsinjuice• Choppedberries,chopped grapes(noneedtopeel)
IdeasforSoftChoppedPhase
StuffedAcornSquashRecipeIngredients:2acornsquash(pleasewashandscrubtheskintorinseoffanydirt)2-3Tbsoliveoil1smallonion,smalldiced3-5clovesgarlic,minced1boxcreminimushrooms,smalldiced1poundgroundturkey1tspItalianseasoningSaltnpepper1can15ozsizetomatosauceShreddedmozzarellacheese
Directions:1.CAREFULLYsliceopentheacornsquashinhalf,lengthwise(toptobottom)andscoopouttheseeds.2.Inashallowbakingdish,placecutsidedown,withalittlewatertobarelycoverthebottom,microwavefor15minutes,in 5minuteincrements,checkingfordoneness around13-15minutemark.Shouldbe“forktender”.Leaveinmicrowaveuntilreadyto“stuff”3.Heatoilinlargesautépanonmediumheat,sautéonionsandgarlicuntilsoft.4.Addmushroomsandsautéuntilshriveled(theywillhavereleasedandevaporatedalotofwater)5.Addturkeyandcrumbleuntilcooked through.SprinkleinItalianseasoning,pinchofsaltandafewgrindsofpepper(redpepperflakesoptional!)6.Stirintomatosauceuntilheatedthrough7.Turnacornsquashoversoskinsideisfacingdown.Filleachsquash“well”withturkeymixture.Sprinkletopswithcheese8.Placeintoasterovenand“broil”topsuntilCheeseisbubblyandmelty!
HighProteinBerryCrumble3/4cupAlmond Flour1/3cupPremierProteinVanillaWheyProteinPowder1TablespoonButter2TablespoonsAlmondButter2Tablespoons SugarFreeVanillaSyrup2cupsofBerries(IusedRaspberriesandBlueberries)
1.Preheatovento350.Washberriesanddivideequallyin 4ramekins.2.Mixcrumble ingredients togethertillclumpsform(addateaspoonofwaterifneeded, it'lldependonalmondbutterbrandsomearethinnerorthickerthanothers.)3.Sprinkleclumpsofthetoppingequallyovereachramekinoffruit.4.Placetheramekinsonabakingsheetforeasyremovalfromtheovenandsavesanyovenclean-upifyourberriesareespeciallyjuicy.5.Bakeat350for25minutes tillgolden.Servewarm,roomtemperatureorcoldwithadollopofGreekyogurt.
Recipecourtesyoftheworldaccordingtoeggface.blogspot.com
SampleSoftChoppedDietBreakfast 1scrambledegg with2slicesthindeliturkey(6g+10gprotein)
Snack 1 stringcheeseand¼cupfreshblueberries(6gprotein)
Lunch ½ cupshreddedskinlesschickenthighwith¼cupblackbeans(14g+4gprotein)
Snack 4oz proteinshake(10gprotein)
Dinner 2oz bakedsalmonwith¼ cup choppedsautéedzucchini(14gprotein)
Snack ½ cupYoplait100vanillaGreekyogurtwith¼cupchoppedstrawberries(10gprotein)
TotalProtein 74gprotein
Week7and8:MaintenanceChoppedTheBariatricPlate
2-3oz.ChoppedLeanMoistMeat- ChooseproteinFIRST-Eatproteinatallmeals- Limit processed/highfatmeats(hotdogs,SPAM,bacon,bologna,pepperoni,etc.=highsalt/fat)- Increaseto+60-80gproteindaily
2– 4TbsHighFiberStarch- Smallestfoodgroup(eattheselast)- Highfiberchoices:quinoa,choppedsmallpotatoes/sweetpotatoeswithskin,peas,corn,beans,lentils,bulgur,couscous,acorn/butternutsquash
½cupnon-starchyCHOPPEDvegetable
- 2nd majorfoodgroup- Lightlysteamed,sautéed
smalldicecrisptendercarrots,broccoli,cauliflower,
choppedcookedleafygreens,etc.- RAW:finelychoppedrawveggies,
shreddeddarkgreensalad(maybewaituntilmonth3ifyourstomachhurts)
About1cupoffoodpermealSnacks:½cupchoppedfruit
withtheirpeelson
SampleMaintenanceDiet
Breakfast 8-11oz ProteinShake(20-30gprotein)
AMsnack ¼cuprawalmondsand½cupchopped apple(7gprotein)
Lunch 2-3oz chopped grilledchickenwith½cupshreddedromainelettuceand1tspdressing(14-21gprotein)
PMsnack 2 LightBabybelcheeseand4Triscuitcrackers(12gprotein)
Dinner 2-3ozbakedHalibutand½ cupbroccoliflorets(14-21gprotein)
TotalProtein 67-91gprotein
AllmealsandsnacksneedPROTEIN!
Bestsourcesofproteinfoods:Leanmeats,eggs,lowfatdairy(lowfatcheese)
Howcanyouaddmoreproteinusingfood?
1ozcookedmeat=7gramsprotein
3ozcookedmeat(deckofcardssize)=18-25gramsprotein(~21grams)
Food Portion ProteinGrams
Beans,blackcooked 1/2cup 7
Beans,kidneycooked 1/2cup 8
Beans,soy/edamame(shelled) 1/2cup 8
Beef,ground95%leancooked 2oz 16
Beef,jerky 1oz 10
Beef,jerkybarbyEpic 1bar 11
Beef/Venison,sirloincooked 2oz 17
Cheese,BabybelLight 1wheel 6
Cheese,cottage0%-2%smallcurd 1/2cup 11Cheese,ricottabyHEBLowFat 1/4cup 7
Cheese,SargentoReducedFatSlices 1slice 6
Cheese,stringcheeselight 1stick 7
Chicken,groundbreastmeat 2oz 10
Chicken, thighskinless 2oz 14
DeliTurkey/Ham,OscarMyerThinDeliFresh 6slices 10
Egg,liquideggwhitesbyAllWhites100% 3Tbs 5
Egg,Egg-BeatersOriginal 1/4cup 6
Egg,largewhole 1egg 6
Egg,largewhite 2whites 6
Fish,salmonSockeyecooked 2oz 14
Fish,salmonpouchbyChickenoftheSea 2.5ozpouch 13Fish,tunapouchbyStarkist 2.6ozpouch 17
Hummus,PitaPalsinglesto-gopack 2oz 6
Lentils,cooked 1/2cup 9
Lentilsoup,Progresso 1cup 9
Consideradigitalfoodscaletoweighout“cooked”meats.OXOfoodscaleisagoodonetouse(Amazon,BedBathBeyond,etc.)
AllmealsandsnacksneedPROTEIN!
Bestsourcesofproteinfoods:Leanmeats,eggs,lowfatdairy(lowfatcheese)
Howcanyouaddmoreproteinfromfood?
1ozcookedmeat=7gramsprotein
3ozcookedmeat(deckofcardssize)=18-25gramsprotein(~21grams)
Food Portion ProteinGrams
Milk,almondandcashewbySilkProteinNutmilk 1cup 10
Milk,cow0%,2%,whole 1cup 8
Milk,cowbyHEBMootopia2% 1cup 13
Milk,cowbyFairlife0%-2% 1cup 13
Milk,soyunsweetened 1cup 7
Nuts,almondsrawwhole 1/4cup 7
Nuts,peanuts(shelled) 1/4cup 9
Nuts,peanutbutter 1Tbs 4
Nuts,peanutbutterpowderbyPB2 2Tbs 5
Nuts,pecanhalves(shelled) 1/4cup 3
Nuts,pistachios(shelled) 1/4cup 6
Nuts,walnutpieces(shelled) 1/4cup 5
Peas 1/2cup 4
Peasoup,Campbell's 1/2cup 9
Pork,loinchopcooked 3oz 24
Quinoa,cooked 1/2cup 4
Seeds,chia 3Tbs 9
Seeds,flax(whole) 3Tbs 6
Seeds,hemp 3Tbs 10
Seeds,pumpkin(shelled) 3Tbs 9
Shrimp,cooked 3oz 18
Tofu,firm 3oz(1inchslice) 8
Tempeh 2oz 11
Turkey,grounddarkmeatbyJenny-Ocooked 2oz 10
Yogurt,Greekplainfat-free 1Tbs 1.5
Yogurt,OikosTripleZero 5.3oz 15
Yogurt,YoplaitGreek100 5.3oz 13
Considerusingmeasuringcupstohelpwithportioncontrol
• Alcohol• Pleaseavoidforatleast6months!!• Waituntilyouhaveagoodroutineof“safe”foodsandarestayinghydrated• AlcoholcontainsEXCESSCALORIESANDSUGAR!(margaritas,sangrias,daiquiris)=slowsdownweightloss!• Maycausevitaminmal-absorption(blocksBvitamins)• Leadstohighbloodalcohollevel
• Youwillgetdrunkquicklywithsmallamounts(wine,liquors)• BecarefulwithbreathalyzertestsandDUIs• Avoid“shots”orsugarycocktails
• Beermaycause“foaming”atthemouthduetocarbonation• Tryathomefirsttoseehowmuchyoucansafelyhandle• Beawareof“transferaddictions”
• Usingalcohol,insteadoffood,asamethodtocopewithemotions=Substanceabuse• Exercise
• Onlyeasywalkingimmediatelypost-op(nojogging,noelliptical)• Noheavylifting/pushing/pulling(smallchildren,pets,groceries)• Liftlessthan10lbs• Wait4-6weeksaftersurgerytoincreaseexercise• After4-6weeks,ifithurts,don’tdoit!• Youmayhaveabdominalpainatthesurgerysite• Riskforumbilicalhernia(intestinepoppingthroughbellybutton)• NoSwimming/Bathes/SaunasuntilOKbysurgeon• TalktosurgeonatyourfollowupappointmentifOKtoadvanceexercise
NutritionDeficienciescandevelopanytime!ØPoordiet(noteatingawidevarietyofmeats,fruits/veggies,healthyfats,grains)
ØNottakingvitamins,ortakingwrongtype
ØEasilyprevented.But,deficienciescangetworsewithoutannualcheckup!• LowB1(Thiamin)
• “Wernicke’sEncephalopathy”numbness/tinglinginhands/feet,irreversiblenervedamage,lossofbalance• B1lossfromfrequentvomiting,B1malabsorptionfromexcessalcoholconsumption
• Example:Post-sleeve16dayspost-op,feelingweak,notdrinkingwater,somebroth,someproteinshakes, vomiting=burning/paininhandsandlegs.SenthertoER
• LowCalcium:Osteoporosis,bonefractures,teethchipping/toothloss
• IronDeficiencyAnemia:Tired/weakness,feelingcold,eatingice,“spoonnails”,paleeyes,hairthinning
• LowVitaminA:Difficultyseeingatnight,nightblindness• LowZinc:Poorimmunity,poorcellrecovery(hairthinning,ridgesonnails)
• LowProtein:Muscleloss,lowenergy,slowweightloss,hairthinning
LoopDS:FunctionsofFatSolubleVitaminsA,D,EandK• VitaminA
• Importantfornormalvision,geneexpression,reproduction,embryodevelopment,growthandimmunefunction• Deficiencies:Mayleadtonightblindness,follicularhyperkeratosis(roughskinwithhard“goosebumps”),impairedimmunity,
itching,dryhair,poorwoundhealing,lossoftaste• Hemoglobinands.retinol:Vit AdeficiencycancoexistwithIrondeficiency,ormakeitworse.ConsideraddingVit AiflowIron
(withapprovalofclinic)• ZincdeficiencycancauselowVit A,especiallyinpatientswithprotein/energydeficiency
• VitaminD• Essentialforbonemineralizationthroughregulationofcalciumandphosphorus;benefitsimmune,endocrineand
cardiovascularsystems• Deficiencies:Inadequatemineralizationofbones(osteomalacia),lowCalciumstores,tetany(musclespasms),metabolicand
autoimmunecomplications• MagnesiumiscofactorinmakingVit Dinliver,maybenefitinaddingMagnesiumifVit Dislow(withapprovalofclinic)
• VitaminE• Antioxidantforprotectingpolyunsaturatedfatsinmembranesphospholipidsandplasmalipoproteins• Deficiencies:nervedamagethroughoutthebody,difficultywalking,skeletalmyopathy(muscledegradation),pigmented
retinopathy,redbloodcellhemolysis• Vit CcanhelprecycleVit E.AddingVit CmayhelpincreaseVit E
• VitaminK• Functionsascoenzymeinsynthesisofproteinsforbloodcoagulationandbonemetabolism• Deficiencies:easybruising,bleedinggums,delayedbloodclotting,heavymenses,nosebleeds,decliningbonehealth• HighVit EmaycounteractVit Keffectsinanticoagulantpatients(bloodthinningvsbloodclotting)
HairThinningo Appears~4to6monthsaftersurgeryo 1st stage:occursduetoshockfromsurgery
• Forcedmalnutrition=Weightloss• 2nd stage:Continuedhairthinningduetopoornutrition
o Beforeconsideringhair/skin/nailsupplement,askyourself:Everyday,areyougetting?• Protein:+80gramsdaily• MultivitaminswithZinc(8-15mg),Copper(1-2mg)• TakingthecorrectamountofmultivitaminsforSleeve/Bypass/DS?• Healthyfats
o Nuts,avocadoo 1-2Tbsgroundflaxseedmixedintofoodso 2000mgOmega3Fishoil(EPA+DHA)
o Then,youcouldconsideraddingaHair/Skin/Nailsupplements• However,theyarenotproventowork• Youcouldtry:
o CelebrateVitamins.com,ortryBariatricEating.com(JourneyVitamins)o AdditionalBiotin2500mcg
DumpingSyndromeDefinition:foodmovingtooquicklythroughGItract
• Earlyonset(immediate)• Liquidsugar/fatfoods(juices,alcohol,smoothies,highfatcreamysoups,juicyfruits)• DrinkingwithmealsExample: 5weekpost-sleeveatePaneraBreadcheesybroccolisoup.WenttoERduetopain,onmorphine from3pmto11pm
1½weekpost-sleevedrankcoffeecreamer.Rantobathroomwithdiarrhea12dayspost-sleeve, gottiredofhisproteinshakes, drankSonicmilkshakethroughastraw.Spitupandhaddiarrhea.10dayspost-sleeve, feelinghungry,atesugar-freeicecream(notfatfree!).Haddiarrhea.
• Lateonset(1-2hoursafter)• Solidsugar/fatfoods(desserts, friedfoods,creamypasta)Example: 2weekspost-sleeve, ate2slicesofBBQsausage.1hourlater:waterydiarrhea,sweating,flushing inface,bodycramps
3monthpost-sleeve, patientate1Frenchfry.45minutes later,feltstomachcramping,nausea,lightheaded
• Symptoms• Lightheadedduetobloodpressuredropping• Fatigue,tired,sleepy• Faintingduetobloodsugardrop(insulinspike,reactivehypoglycemiaduetohighsugar/toomuchcarbs)• Nausea,stomachcramping,rapidheartrate,hotflashes,feelingflushed/sweating/clammy,diarrhea
• Todecreasechancesofdumping:balanceallmeals/snackswithBOTHproteinandhighfibercarbs
• Overtime,youcanbuildupatolerancetohighfat/sugaryfoods.• Dumpingsymptomswon’tbotheryouanymoreifyoucontinueeating junkfood =weightregain
Gout:Typeofarthritis(suddenpaininjoints)• Symptoms:suddenseverepain,swelling,rednessandverytender• Commonareasaffected:bigtoe,ankles,knees,elbows,wrists,fingers• Causes:Uricacidcrystalsbuildupinyourjointsifkidneysarenotabletoexcretethem.• Riskfactors:
• Heavymeatdiet(redmeat,organmeats,turkey,seafood)containpurines.Purinesarebrokendownintouricacid.
• Highalcoholandsugarybeverage(highfructosecornsyrup,fructose-fruitjuices)consumption• Highproteindietandnotenoughwater• Obesity:bodymakesmoreuricacidandkidneyscannoteliminatethemeasily• Highbloodpressure,kidneydisease
• TreatmentandPrevention:• Seethedoctorandgetonmedication• Stayverywellhydrated• Limitoravoidalcohol• Limitmeat,seafoodandpoultryasproteinoptions• Loseweight
Constipation
• Commoncomplicationaftersurgery• Notdrinkingenoughwater• Increaseintakeofproteinandvitamins/minerals
• STAYHYDRATED:• +64ozwater/lowcalorie-lowsugarbeverage
• FIBER:Aimfor25-30gramsoffiberdaily.• FullLiquid:Pureedveggie/beansoups(blackbean,pea,lentilsoups),8oz“light”prunejuice/day• Pureed:Pureedveggies/fruits,mashedbeansorlentils,instant“plain”oatmeal• SoftChopped:Highfibercrackers+3gramsoffiberperserving,plainbranflakes,FiberOneOriginalBranCereal(sticks,notflakes),wholebeans,stewedchoppedprunes
• BeneFiberPowder:2Tablespoonseachdose,twicedaily;oranynon-thickeningfiberpowdertomixintofoodsorliquids(notMetamucil)
Constipation(continued)• LAXATIVES:
• MilkofMagnesia• MiraLAX powder
• 1capfuldissolvedinto8ozwater,taken1-2xdaily.Cleardissolving/tastelesspowderabsorbswaterintocolontosoftenstooltopasseasily(osmoticlaxative)
• SmoothMoveTea• 1cupatnight.Thisisacaffeinefree,herbalteawithSenna,anaturalgentlelaxative,availableatmostpharmacies;stimulatescolontocontractandpushstoolthrough(stimulantlaxative)
• PROBIOTICS:• Anyover-the-counterbrandissafetotry(Align,Culturelle,etc.)Youcanopenupacapsuleandmixtheprobioticpowderintoanynon-dairyfoods(applesauce,oatmeal,etc.)• TherearemanydifferentstrainsofbacteriathatmayhelprelieveGIissues.
• BariatricAdvantagehasachewableprobiotic(ChewableFloraVantageProbiotic:availableatTLCofficeaswell)
Constipation(continued)• PHYSICALACTIVITY:• Dailywalkingforatleast30minutescanhelpstimulatebowelstomove
• RE-POSITIONYOURSQUAT:• SquattyPottytoiletstoolhelpstore-alignyourbowelswhileyousitonthetoilet,allowingforeasierpassageofstoolthroughyourcolon.
• Callourofficeifconstipationdoesnotresolve
DehydrationisaBIGDEAL!Causes:notdrinkingenoughwater,vomiting,diarrhea
GOAL:~64ozdaily,atleast¼cup(2oz)ormore,every15minutesStayinghydratedisyour#1priorityalways,especiallyduringthesurgeryhealingprocess.Dehydrationcanhappenfast,andisveryseriousmedicalconcern.Youwillbere-admittedbacktothehospital forIVhydration.
SignsofDehydration• Mild:darkyellowurine,strongodorinurine,noenergy,drymouth,lightheaded,headache• Moderate:Lessurine,dry/sunkeneyes,poorskinelasticity,difficultywithconcentration• Severe:Nourine,possiblekidneyfailure,lethargic,vomitinganddiarrhea,shock
CARRYWATERATALLTIMES,EVERYWHEREandSIPALLDAYLONG!!
BariatricIVBag500mgThiaminFolicAcidVit/Min
StrategiestoStayHydrated• FocusonhydrationFIRSTbeforeproteinandvitamins
• Haveasourceoflowsugar/non-protein formofbeveragewithyouatalltimes.• Proteindrinksdonotcounttowardshydration(proteincausesconstipation)• Anylowcalorie/lowsugarbeveragecounts(referbacktoyourclearliquidoptions!)
• Determinehowmanydrinkingcontainersyouneedtogothroughinadaytoreach64oz.• Ex:Mywaterbottleis30oz.Iwillneedtodrinkatleast 2perday.
• Useyourphonetohelpsettimers/reminderstodrink• 15minutealarms,smartphoneapps:Baritastichaswaterreminders
• Switchupbeveragetemperature• Addice,roomtemperature,orhotherbaltea/hotbroth.Hotliquidsmayalsohelprelaxswelling.
• Switchupbeverageflavors,lowsugar/lowcalorieclearliquid• “spawater”infusedwithherbs(mint,basil)mfruits(citrus,berries,cucumbers),CrystalLight
• Switchupbrandsofwater!• Filteredwatermaybe“scratchy”sotrybrandsofbottledwater(Fiji,Evian,Aquafina,etc.)
• Eatyourliquids:SFjello,SFpopsicles,icechips
SampleHydrationSchedule9:00am 2ozchamomiletea9:15am 2ozchamomiletea9:30am 2ozchamomiletea9:45am 2ozchamomiletea15minutebreakbeforeeating - -30minutebreakaftereating - -11:00am 2ozicecoldwaterwithlemon11:15am 2ozicecoldwaterwithlemon11:30am 2ozicecoldwaterwithlemon11:45am 2ozicecoldwaterwithlemon15minutebreakbeforeeating - -30minutebreakaftereating - -1:00pm 2ozCrystalLightPure1:15pm 2ozCrystalLightPure1:30pm 2ozCrystalLightPure1:45pm 2ozCrystalLightPure15minutebreakbeforeeating - -30minutebreakaftereating - -3:00pm 2ozwarmlowsodiumchickenbroth3:15pm 2ozwarmlowsodiumchickenbroth3:30pm 2ozwarmlowsodiumchickenbroth3:45pm 2ozwarmlowsodiumchickenbroth4:00pm 2ozminttea4:15pm 2ozminttea4:30pm 2ozminttea4:45pm 2ozminttea15minutebreakbeforeeating - -30minutebreakaftereating - -5:00pm 2ozstrawberry/cucumberinfusedwater5:15pm 2ozstrawberry/cucumberinfusedwater5:30pm 2ozstrawberry/cucumberinfusedwater5:45pm 2ozstrawberry/cucumberinfusedwater15minutebreakbeforeeating - -30minutebreakaftereating - -8:00pm ½sugarfreepopsicle(2oz)8:15pm ½sugarfreepopsicle(2oz)8:30pm ½sugarfreepopsicle(2oz)8:45pm ½sugarfreepopsicle(2popsiclestotal)9:00pm 4Tbssugarfreejello9:15pm 4Tbssugarfreejello9:30pm 4Tbssugarfreejello9:45pm 4Tbssugarfreejello
Ifyouarehavingdifficulttimestayinghydrated…• Thissamplehydrationscheduleistoshowyouhowtopaceyourselfthroughouttheday
• Aimtodrinkatleast2oz(1/4cup)offluidsevery15min• Astandardmedicinecupis1oz=2Tablespoons=1/8cup• 2medicinecups=2Oz=4Tablespoons=¼cup• SIPPINGalldaylong
• Overthenext1-2months,theswellingwillreduce,youwillbeabletodrinkinglargeramounts.ItjusttakestimeJ
• ItisOKtodrinklarger(morethan2ozevery15minutes)andfasteramounts,insteadofsipping,ifyoufeelcomfortable
TrappedAirfromDrinking
• Duetoincreasedpost-surgeryswelling(hiatalhernia),trappedairorgascancreateburping,chestpressureandpain• Causesofinhalingtoomuchair
• Drinkingfromopencontainers• Chewing/smackingongum• Carbonateddrinks(sodas,carbonatedwaters,etc.)• Drinkingthroughstraws
• Youcantrydrinkingthroughstraws,chewinggumifyoudonotfeelchestpain• Manypatientsavoiddrinkingsodaspermanently
• Considerusinga“sportstop”squirtbottletohelppreventsuckingintoomuchair.
Caffeine• Youmayaddthesebackintoyourdietif:
• Youarewellhydrated(goodlevelsofenergy,urineislightyellow,notconstipated)• Donotfeelanyacidrefluxsymptoms
• Caffeine• Caffeineisadiureticwhichcancausemorefluidlosses=dehydration
• Ifyoumustaddcaffeinebackintoyourdiet,makesureyouareabletodrinkenoughwatertostayhydrated(yoururineisclear)
• Caffeineblockstheabsorptionofminerals(calcium,iron)
• Avoiddrinkingcaffeinatedbeverageswhenyoutakeyourvitamins.Keeptheseseparateatleast2hours
• Caffeinemayirritategastriculcersorstimulatemoreacidproduction
Sodas,StrawsandGum• Liquids,air,gas/carbonationwillnotstretchyourpouch.• Youmayaddthesebackintoyourdietif:
• Donotfeelchestpainfromswallowingextraair
• Sodas,StrawsandChewingGum• Carbonatedbeveragescancreatealotofgaspressureintoyourpouch.Itmaycausediscomfortinyourchest
• Drinkingthroughstrawscanleadtoswallowingalotofair,alsocreatingmorepressureinyourpouch.Also,drinkingthroughstrawscancausealargeamountoffluidstobeconsumedveryquickly.
• Chewinggummayleadtoswallowingmoreair,causingfullnessaswell• Youmaytrydrinkingcarbonateddrinks,usingstrawsandchewing(notsmacking)ongumwhenswellingisreduced,~2months
• Becarefulasthismaycausechestpainfromgas/airanddifficultyreleasingburps
GasandDiarrhea• Morecommoningastricbypassandduodenalswitch/loopDS• Excess/FoulSmellingGas
• Devromcapsules/chewabletablets(devrom.com) 200mgbismuthsubgallate• Eliminatesodorsfromgasandbowelmovements
• Gas-xStrips, Lactaidpills,Beanopills• Walkingcanhelptoo!
• Diarrhea• Lactose(Dairyproducts)• Toomuchfiber/roughage fromrawveggies(salads)• Floatinggreasystools
• AvoidfollowingKetogenicdiets(highfatfoods)
• LactoseIntolerance• Symptoms:Gassy,bloated,stomachcramping,diarrhea• Stopdrinking foodsandshakeswithLACTOSE
• AvoidWHEYCONCENTRATE (containslactose):“readytodrink”shakes(Premier,MuscleMilk)• SwitchtoWHEYISOLATE(lactosefree):found inmostprotein“powders”orprotein“drinks”• SwitchtoLACTOSEFREEmilk
• YoumayhaveaMilkAllergy• AvoidproteinproductswithWHEY/CASEIN/MILKprotein.ThesecontainMILK.• Stayawayfromanymilk/dairyfoods (milk,yogurt, cheese,cottagecheese)• Useunsweetsoymilkornutmilkinstead• Chooseplantbasedprotein(VegaSport, PlantFusion,GardenofLife:RawMeal)
MetallicTaste,MouthOdorandDryMouth• Maybeduetolowcarbohydrate/higherproteindiet,ketosis,dehydration,changesinyourmetabolism,ormedications
• Solutions:• Tryrinsingyourmouthwith:
• 1tsp.saltwith1cupwarmwater,or1tsp.bakingsodawith1cupwarmwater• BioteneDryMouthOralRinse:1Tablespoon,rinsefor30seconds,mayuseupto5xdaily
• Continuesippingonwaterorlemonwaterallday• Trysuckingonsugarfreelemondrops(acidslikelemonhelpproducemoresaliva)• TrysuckingonsugarfreecandiesmadewithXYLITOLtostimulatesalivaproduction• Avoiddrinkingcaffeine(green/blacktea,regularcoffee)• Alcoholdriesyourmouth:Avoiddrinkingalcohol,avoidmouth-washesthatcontainalcohol(Listerine)• YoumaytakeVERYSMALLSIPSwithyourmealsifyourmouthisextremelydry
• Maintaingoodoralhygieneasdrymouthcanleadtoworsebadbreath,fungusovergrowth(thrush)andcavities
• Thesesymptomswillimproveasyoubeginaddingmorevarietyoffoodsovertime
VomitingandSpittingUp• “Sliming”=SalivaPooling/Foamingatbackofthroat
• Whenfoodisstuck,yourbodydevelopsfluidstolubricatetheobstructionandsalivabacksup• VomitingandFoodgettingstuckisdueto:
• Eatingtoofast• Eatingtoomuch…even1bitetoomuch (pressurebuildsupinyourpouch)• Takingtoolargeofabite• Notchewingwellenough
• Solutions:• SLOWDOWN!!• CutyourfoodintoverysmallpiecesBEFOREyoustarteating• Putyourforkdowninbetweenbites.• Cheweachbiteintoamush(pureed texture)beforeswallowing• Eatsmallerportions.Usesmallerplates,measureandweighyourfood• Standupaftermeals,stayuprightforawhile,walkaroundtohelpdigestfood
• VomitingonaweeklybasisISNOTNORMAL!• Callourofficetonotifysurgeon,dietitian,nursepractitionerassoonaspossible!• DONOTWAIT!
ChestPainandNausea• ChestPain• Swellingfromhiatalherniarepair(~2months toresolve)• Eatingtoolargeofabite,notchewingwell• Foodpreparedinatoughway(overcookedmeats/eggs).• Eatingthewrongfoods tooearlyduring thedietprogression!• Eatordrink toomuchandtoofast;eating/drinking together• Swallowingair:drinking fromstraws,smackingongum,drinking carbonatedbeverages• Solutions
• Standupandwalkaroundaftereating, stayupright• Changetemperatures:icecoldliquidsorhotteamaybemorerelaxing• Considerdrinking through “sportstop”waterbottletodecreaseairbubbles• Takeverysmallbitesandchewwell;donoteatanddrinktogether• Eatslowlytodetectearlysignsoffullness,donotovereat• Stopeatingthatfoodandre-trynextmonth.Perhapsyourstomachisstillhealing
• Nausea• Eatcold/roomtemperature,orbland foodswhichhavelessodor (applesauce,avocado,oats,crackers,potatoes,broth)• Eatsmallmeals.Chooselight (notheavymeaty,greasymeals)• Sniffing coffeebeans,peppermintoiltogetridoffoulodors• Calmyourstomachwithherbaltea:mint/ginger/chamomile teas• Sliceup2thinpiecesoffreshginger, steepinacupofhotwatertomakegingertea.OKSugarsubstitutes• Useplasticutensilsinsteadofsilverware(lessmetallicodor)• Callourofficetodiscusswithsurgeonornursepractitioneraboutanti-nauseamedications(Zofran)
DifficulttoDigestFoods
• Tough/DryProteins• Especiallychickenbreast,dryporkchops,chewy/well-donesteak• Donotdrowninsauce!• Considerchangingfoodpreparationforeasierdigestion• SlowCooker,InstantPot• Marinate/brinemeatssotheywon’tbetoodry• Usingmeatmallettopoundthin/tenderize• Choosedarkmeat(moremoist).Pleaseremovechickenskin(highinfat!)• Choosetendercuts/thinlyslicedmeats:ham,roastbeef,potroast• DonotOVERCOOKmeats/eggs.Avoidre-heatingproteinsinthemicrowave(willturntoughandrubbery)
• Rawveggies,leafygreens,unpeeledfruits• Iffoodisnotpreparedintosmallpieces,theywillbeverydifficulttochewthoroughly• Finelyshredsalads,rawleafygreensandrawveggies• Chopintosmallpieces:stringyveggies/cookedleafygreens• Insteadofapplechunks,trythinlyslicedapples
StrategiestoAvoidFoodsGettingStuck
GetRidofBread!• Bread(includingRolls,Bagels,PizzaCrust)/Rice/Pasta/Tortillas:• STAYAWAYFOR6MONTHSORLONGER!• Manypeoplehavetroubleeatingthesefoods• Getstuck• Becomegummyandexpandslikeasponge(chestpain,vomiting)
• Veryfilling• Fullfrombread(Subwaysandwich)• Noroomtoeatmorenutritiousfoods(proteinsandveggies)
• Highincalories,butlittlenutrition(usuallywhiteflour,nofiber)• Fluctuatesbloodsugars(highsandlows),cravingmorecarbs
• Choosehighfibercarbohydratesinstead!• Lookforfiber+3gramsperserving• Highcrackers(Triscuits),highfiberplaincereals(bran,steelcutoats,shreddedwheat)• Beans,lentils,peas,quinoa,oats,cauliflowerrice,zucchininoodles,acorn/butternut/spaghettisquash,sweetpotatoes/smallpotatoeswithskins• Avoidgluten-free,lowcarb,zerocarbstarchsubstitutes=junkfood!
DONOTGETPREGNANT!
• Waituntilafter18months(1yearandahalf)tostartplanningapregnancy• Itisnotadvisabletobepregnantatthetimeofsurgeryorsoonaftersurgery• Propernutritiontosustainthegrowingfetusvs.Propernutritionforweightloss
• Ifyoufeelfrisky,YOUNEEDTOUSEAMETHODOFCONTRACEPTIVE• Birthcontrolpillsmaynotbeabsorbed(talktosurgeonoryourgyn)• Engageinsexifyoudonotfeelpain,waituntilafter1month• You aremorefertileafterweightloss
• Ifyougetpregnantduringyourweightlossjourney,youmayhaveadifficulttimegettingbackontrackwithweightloss• Reachingyourweightlossgoalmaybemoredifficult
• Childrenborntoobesemothersaremorelikelytobeobese• Motherswhohavelosttheweightafterbariatricsurgeryaremorelikelytohavenon-obesechildren
• SEX:wheneveryoufeelcomfortable(butifithurts,don’tdoit)
WeightLossPlateausandWeightRegain• Weightlossstallswillhappen throughout your journey• Somestallsmaylast~1month…and theweightlosswillpickupagain– DON’TPANIC!• Assessyourlifestyle
• Haveyoubeencheatingwithhighcalorie,highsugarfoods/beverages, drinkingmoreALCOHOL?• Chips,sweets,sodas/juice,bread/rice/pasta
• Areyoudiningoutmorefrequently?• Areyoueatinglateratnight?• Skippingmealsandsnacking/grazingmorefrequently?• Areyoueatinglargerportions? Eatingafewbites,waiting30minutes, theneatingsomemore…• Drinkingandeatingtogether?• Eating“sliderfoods”– saucy/liquidy/soft/mushy foods
• Covering foodwithsoups/saucessotheyareeasiertoswallow• easytoeatanddigestfoodswhichleadstoLARGERPORTIONS
• Areyouexercisingaregularbasis• Addweightlifting2xweek• Perhapsitistimetochangeupyour routine, increasetheintensity
• Areyougetting64ozwater,+80gramsprotein, takingallyourvitamins?• FocusonQUALITYvs.QUANTITY
• Smallbitesoffastfoods….ISSTILLFASTFOOD!!!• Ittakesabout1.5to2yearstoreachweightlossgoal• Continuing properdietandexerciseisCRITICALtohelpkeeptheweightoff (weightlossmaintenance)
Howto“Cheat”withBariatricSurgeryYouwillbeabletoeatlargerportionsif:• Drinkwithmeals,havingonlyliquidmeals(abowlofsoup)• Coverfoodswithsauce(gravy,dressings, soups)• Choosesofttexturefoodssotheywilllesslikelyget“stuck”(avocado)• Chooseprocessed/greasy/oily foods:Cheese,icecream,chipswillnevergetstuck
Donotdrinkwithmeals. Permanently,avoidmixingliquidsandsolids• Forthe1st 2months
• wait15minafterdrinking,theneat• Wait30minaftereating,thendrink
• After2months, youcanjustallow~5mininbetweeneatinganddrinking• Avoidhavingadrinking glassduringmeals
Stopeatingliquid/pureedmealsstartingatWeek5ChoppedSolidPhase• Trytoeatonly solidfoods (mealsthatrequirechewing)• “Chewing”slowsyoudown,allowing forabettersenseoffeelingfull• Focusonfoods thatrequirechewing.Useaknifeandfork(not spoon)
• Eatwholefruitandveggiesnotpurees.Slicedapplesvsapplesauce;smallpotatoeswithskinvsmashedpotatoes• Soups,mushyandsaucyfoods(refriedbeans,bananas, chickentortillasoup,chili)don’trequiremuchchewing• Ifmealsareeasytoeat(noneedtochew),youwilleatthemfaster =youmayeatlargerportions• Slowdownandchew:Tryyogurtwithchoppedfruitandnutsandbranflakes.ThisforcesyoutoSTOPandCHEW!
TrackYourProgressKeepalog/journalofyourmeasurements,water,vitamins,exercise,protein!• Freemobileapps:MyFitnessPal,Baritastic,LoseIt!• CalorieKingnutritiondatabase• Freemobileappstologintake,setalertreminders,trackprogress
TipsforSuccess:• Usesmallerplatesandsmallutensils
• 6-8inchsectionedplate(kid’splate,saladplate,breadplate)• Considerusingbabyspoons/cocktailforks/iceteaspoontohelpwithsmallerbites
• Considerafoodscaleandmeasuringcups
• Eatslowlyandcomfortablyforonly30minutes• StopeatingwhenyouareCOMFORTABLYfull/satisfied(maybe<30min)• Putyourforkdowninbetweenbites.• Cheweachbiteuntilitismush• Thenafter30minutes,getupandwalkaway• Removefoodfromyoursight
• DONOTeatafewbites,thenwait10-30min,thengobacktoeat…• ThisisGRAZING!YouwillbeabletoEATLARGERPORTIONS• Eatwhatyoucaninasettime,thenhaveyournextmeal2-3hourslater.• Pre-portionyourmealsaheadoftime
• Carrywater andpackyourownhealthysnacks• ~64ozwater/lowcaloriebeveragedaily• +80gramsproteindaily
• Proteinatallmeals• Hardboiledeggs,Greekyogurt,stringcheese,nuts,delimeats• BeginningWeek5
• Proteinbars(<250calories, <10gfat,<10gsugar,>5gfiber,>10gprotein)• Proteinchips(sold atTLCClinicorAmBari)
LifelongTipstoKeepinMind• HYDRATIONFIRST!!
• Drink+64ozlowcaloriefluidsdaily;Carrywater/lowcaloriebeverageeverywhere
• PROTEIN• Consume+80-100gramsproteindaily:
• proteinshakes,leanmeats,eggs,lowfatdairy• LoopDSneed+120gramsproteindaily• Eatproteinwithallmeals.Aimfor20-30gramsproteinpermeal.• Startyourdaywith20-30gramsprotein
• Aneasywaytostartoffyourdayiswithaproteinsupplementforbreakfast• EatProtein1st,veggies2nd,saveminimalamountsofstarchesaslastfoodgroup• ThePowerofProtein
• Feelmorefullandsatisfied,energizedfortheday,helpswithweightloss,maintainmuscle
• VITAMINS• MultivitaminandCalciumDAILY,FOREVER!• Nogummyvitamins• Besuretotakethecorrecttype!
LifelongTipstoKeepinMind• BEHAVIORSRELATEDTO“HOWYOUEAT”• Slowdownwheneating.• Sitdownatatabletoeat.Donoteatonthego:whilewalking,driving• Payattentiontowhatandhowyouareeating:Turnoffalldistractions(DonoteatwhilewatchingTV,inthecar,onthecomputer/phone)
• Makeyourmealslast30minutes.Ittakes~20-30minutesforyourstomachtosendfullnesssignalstothebrain• Beforeyoueat,cutallyourfoodintodimesizepieces.• Takeonebiteatatime.Putyourforkdowninbetweenbites.• Cheweachbiteuntilmush,thenswallow.Thenyoumaypickuptheforkforthenextbite.• Donotdrinkliquidswithmeals.Wait~5minutesbeforeandaftereatingtodrinkfluids.• Ifyoufeelfullafterafewbites,thenstopeating.Putthefoodaway.Haveanothermeal2-3hourslater.
LifelongTipstoKeepinMind• Makeallyourbitescountwithhighqualitynutrients. Don’tfilluponuse-lesscarbs• Watchoverallcalorieintake:highfatMEATSareveryhighincaloriesandunhealthysaturatedfats,nomatterhowhighinprotein!
• Avoidhighfatfoods:friedfoods,creamysoups/sauces• Avoidhighsugarfoods:candy,desserts.• NEVERdrinkyourcalories:fruitjuices,smoothies,sodas• Eatlesspackages/processed/restaurantfoods:highcalories,highinsalt!• Readnutritionlabels.Keepallyourfoodslessthan10gramssugarperserving!• Limitsnackingthroughouttheday.Youmaynotreallyneedthisextrasnack.• Nonighttimesnacking!• Intermittentfasting:Allow12hoursinbetweenyourlastmealandtomorrow’sfirstmeal• Exercise+5daysweek:+30minutes/dayofcardioand+2daysofresistancetraining• Avoidfollowing“fad/trendydiets”thatarenotrealisticandsustainableforthelongterm.• Donotconsumelessthan1000caloriesperday!Yourmetabolismwillslowdown
• Eachperson’scaloriegoalisdifferent.• Continueallbariatricnutritionguidelines:water,protein,vitamins,exercise,etc tomaintainweightloss.
• Donotstopadheringtotheseguidelinesoryouwillregainyourweight,ordevelopmalnutrition.
FollowUpCareisCriticalforWeightLossSuccess
• Post-OpSchedule• ~2weekFollowupwithsurgeonandattendpost-opnutritionclassonsameday,ifpossible
• YOUNEEDTOSCHEDULETHESE2APPOINTMENTS!• 3months(labwork)– checkyourinsuranceforapprovedlabfacilities!
• Labs:fastingatleast8hours,stoptakingvitaminsforatleast24hours• 6months• 9months• 12months• Onceayear(labwork)
• FREEPost-OpNutritionClass:FIRSTBITECLASSwithDietitian• Thisisamandatorynutritionclassat~2weeksPost-Surgery• Discusslong-termpost-surgerycareandweightlossmaintenance• BRINGSOMETHINGTODRINKWITHYOUTOCLASS!!!Dehydrationisverycommon
• ScheduleaPrivateNutritionConsultationat6monthspost• Ifyouhavequestionsaboutanything,don’thesitatetocallus!!!713-493-7700
AfterSurgerySupport•Monthlypost-opsupportgroup• 1st Thursdayofthemonth,6pm• HermannDriveSurgicalHospital(FormerlyVictoryHospital)• 2001HermannDrive,Houston,TX77004• 1st floorconferenceroom• EnterviaHermannDriveSurgicalHospitalEmergencyRoomlocatedinrearofthebuilding
• Rotatingtopicsandspeakers• [email protected]
OnlineBariatricResources
• www.TLCsurgery.com• Recipes,handouts,thispacketisalsoavailableonline• Facebook:TexasLaparoscopicConsultants• CheckusoutonInstagram:tlcsurgery
• www.BariatricEating.com• Greattipsandarticles,recipes,theyalsosellproteinandvitamins
• TheWorldAccordingToEggface.blogspot.com• Gastricbypassblog,sellsBentoBox(bentology.com)
• www.CalorieKing.com fornutritioninformation(freeapp:CalorieKing)
• CalorieandWeightTrackers• Livestrong.com,Sparkpeople.com,Baritasticapp• Myfitnesspal.com;FitDay.com,DailyBurn.com,LoseIt!app
• RecipeBooksonAmazon• “EatingWellAfterWeightLossSurgery”• “RecipesforLifeAfterWeightLossSurgery”• “FreshStartBariatricCookbook”
BentoBoxBentology.com
ForadigitalcopyofthispresentationCheckoutourwebsite:www.tlcsurgery.com,hoveroverPATIENTRESOURCESandthenclickonNUTRITIONCLASS(Thisisaverylargefileandcannotbesentviaemail.Also,tohelpsavepaper,only1copywillbeprovidedtoyou)