Nutrition Class for Weight Loss Surgery Preparation€¦ · • Low calorie/sugar/carb: to promote...

NutritionClassforWeightLossSurgeryPreparation

LinLinShao,[email protected]

713-493-7700

TopicstoCover• NutritionClass

• ProteinandVitaminRequirements• PreandPost-SurgeryDiet

• FirstBiteClass(post-surgery)• Complicationsaftersurgery• StrategiesforSuccess

vDONOTLOSETHISPACKET!Itcontainsmanyanswerstoyourquestions!vPLEASEUSETHISPACKETASYOURGO-TONUTRITIONGUIDELINESvDONOTUSEGUIDELINESFOUNDONLINEORGIVENATTHEHOSPITALvEMAIL/CALLMEIFYOUSEEDISCREPANCIESORHAVEQUESTIONS

[email protected]

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


• completemultivitaminandmineral• 25mgB1• 500mcgB12• 3000IUVitaminD• 45mgIron• 10,000IUVitaminA• 20mgVitaminE• 120mcgVitaminK

• StillneedCalciumChewyBites• 2000-2500mgCalciumCitrate• 500mgx4daily• Keepcalcium2hoursapartfromyourmultivitamin

SleeveVitaminsMenstruatingWomenAnemicMenandWomen

• UltraSolowithIron• Swallow1capsule/day

- OR-• AdvancedMultiEA


• completemultivitaminandmineral• 25mgB1• 500mcgB12• 3000IUVitaminD• 45mgIron


SleeveVitaminsNonAnemicMenNonAnemicWomenwhoare:Post-Hysterectomy,Menopausal

• “BariatricAdvantage”UltraSoloWITHOUTIron• Swallow1capsule/day

- OR-

• “CelebrateVitamins”MVSoftChews• Chew2squares/day• Doesnotcontainiron

• Bothoptionsinclude• completeMultivitamin• 500-1000mcgB12• 3000IUVitaminD• NoIron


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


Sleevedonot need Iron- Non-AnemicMale- Post-Hysterectomy/Post-Menopausal/Non-AnemicFemale

Ultra Solo WITHOUTIronx1- or-MultivitaminSoftChewx2


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)

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