Nutrition Class for Weight Loss Surgery Preparation · Nutrition Class for Weight Loss Surgery Preparation Lin Lin Shao, Dietitian [email protected] 713-493-7700 ... • Losing

NutritionClassforWeightLossSurgeryPreparation

LinLinShao,[email protected]

713-493-7700

TopicstoCover• ProteinandVitaminRequirements• PreandPost-SurgeryDiet• Complicationsaftersurgery• StrategiesforSuccess

vDONOTLOSETHISPACKET!Itcontainsmanyanswerstoyourquestions!vPLEASEUSETHISPACKETASYOURGO-TONUTRITIONGUIDELINESvDONOTUSEGUIDELINESFOUNDONLINEORGIVENATTHEHOSPITALvEMAIL/CALLMEIFYOUSEEDISCREPANCIESORHAVEQUESTIONS

[email protected]

ExerciseisIMPORTANTFORWEIGHTLOSSStartaregularlyscheduledexerciseroutine• 5daysaweek:30minutes/daycardio

• Getyourheartrateup!• Walking,cycling,elliptical,jogging,rowing

• 2daysaweekresistancetraining• Liftweightsoruseresistancebands• Buildingmusclewillimproveyourmetabolism=moreweightloss!

Power-systems.com VersaLoops

HEALTHYNUTRITIONHABITS

- LearntogroceryshopforYOUROWNFOOD!- Learntoprepare/packyourownmealsandsnacks.Limitpackagefoods.- Dineoutless(restaurantsservelargerportions,andhavemorecalories!)- Learntoreadlabels

- Sugar<10gperserving- Fiber>3gperserving- %DailyValue:Followthe“5and20Rule”

- Nutrientsnear5%islowandnear20%ishigh- Lookatthesamplelabelontheright- TotalFatis20%=veryhighfatfood- SaturatedFatis25%=alsoveryhigh- Sodiumis19%=highinsalt

- Don’tdrinkyourcalories!- Liquidsugar=Sweettea,soda,juices,coffeedrinks,smoothies,Gatorade/sportsdrinks

- Forevery4gsugar=1tspsugar=1packetsugar- Checkoutwww.calorieking.com fornutritioninformationonfoods

BasicFoodGroups• Carbohydrates

• Bestchoiceandlowestincalories:“Non-starchy”veggies:broccoli,carrots,cauliflower,lettuce,tomatoes,beets,zucchini,etc.Noveggiejuices

• Smallamounts• Starchveggies:peas,corn,potatoes,sweetpotatoes,beans,lentils• Grains:barley,oats,wheat(crackers,100%wholewheatbread,wheatpasta),brownrice,quinoa• Fruit,anykind.Nofruitjuices.Limitdriedfruits

• Protein• Bestchoice:leanmeats,lowfatdairy,eggs,soy• Thesecontainsmallamountsofprotein:nuts,seeds,beans,lentils

• Fat• Bestchoice:oliveoil,avocadooil,nuts,seeds,avocado• Smallamounts

• Butter,coconutoil,cheese,heavycream,creamcheese,mayonnaise,saladdressing• Avoidtransfats=partiallyhydrogenatedoils

• Margarine,cakefrosting,vegetableshortening

BeAwareofYourBehaviorsRelatedtoFoodEmotionalEating- Eatingtodistractusfromnegativefeelings,eatingduetostress/anger/sadness/grief/boredomMindlessEating- Eatingwhileengaginginotheractivities.Thisleadstoover-eating,eatingbeyondfullness- Ex:Snackingoutofthecontainerduringotheractivities(TV,driving,computer,phone)HabitualEating- Automaticdailyhabits,trainedyourselfintoanunhealthyroutine- Ex:Automaticallyturningtocomfortfoodsintimesofstress(emotionaleating)- Ex:Starbuckseverymorning.Vendingmachinesnackat3pm.Pickingupfastfoodonthewayhome.Goingtobedonafullstomachsoyoucanfallasleep.

Thesehabitscanreturnandmayleadtoweightregain- StronglyconsidertalkingtoapsychologisttodiscussCognitiveBehaviorTherapy/BehaviorModifications

WeightLossSurgerydoesnotfixthesehabitsrelatedtofood,itdoesnotfixemotionaleating.

Medical“FYIs”BeforeSurgery

• Reviewyourchecklisttowhatelseyouneedtocomplete• GETYOURCPAPONifyouhavesleepapnea!

• Lowbloodoxygenlevelsmaypostponeyoursurgery

• STOPSMOKING!• Atleast1monthbeforesurgery.Andneveragainaftersurgery.• Riskforbloodclots(death),poorcirculationandpoorhealingaftersurgery,affectsbreathingunderanesthesiaduringsurgery,causesulcers/leaksinthestomachpouch

• Getyourpre-surgerylabscompleted!!• Didyougetalaborderfromus?Weneedtoreviewyourbloodworkbeforesurgery

• Aimtoloseweightbeforesurgery• Donotgain!!• Losingsomeweight(>5%ofyourcurrentweight)beforesurgeryallowsthesurgeontomoreeasilyoperateonyou,therewillbelessbloodlossduringsurgery,andyouwillhaveafasterrecovery

Medical“FYIs”BeforeSurgery• Ourofficewillcallyouwhenyouareapprovedforsurgeryandwewillhelpyouto…• Scheduleyoursurgery,tellyouwhentostart2weekliquiddiet,andtoscheduleyourpre-opappointment.

• Youcanalsocallouroffice713-493-7700tocheckonyourprogress• YourPatientNavigator:LaShanforDr.Scarborough,EsmeraldaforDr.Yu,KarinaforDr.Mehta

• Pre-OpAppointmentatTLCClinic(~14daysbeforesurgery)• Makealistofyourmedications/supplementsandquestions(returntowork,exercise,etc.)forthesurgeontoreview

• Doesyourdiabeticmedicationsneedtobeadjustedwhileon2WeekPre-OpLiquidDiet??

• Pre-AdmissionTestingatyourhospital(~5daysbeforesurgery)• Atyourpre-opappointment,youwillfindoutyourassignedhospital

• STOPHERBALSUPPLEMENTS:2weeksbeforesurgery• St.John’sWort,BlackCohosh,MilkThistle,Melatonin,Turmeric,Ginseng,GingkoBiloba,etc.• BringthislisttoyourPre-Opappointmentforthesurgeontoreview• Thesecanincreasesthechancesofbleedingduringandaftersurgery

Medical“FYIs”BeforeSurgery

• Duringoff-hours,oneofoursurgeonsisoncall.• Pleasecallouroffice713-493-7700 andouransweringservicewillpickup• Theywillpagethesurgeontoaddressyourmedicalconcerns

• Ifthisisamedicalemergency,pleasecall911• Becomefamiliarwithahospitalnearbyyourhomeincaseofemergencies.• It’shelpfulifthishospitalhasabariatriccenter/surgeononstafftoappropriatelytreatyou.

TakeVitaminsBeforeSurgery• StarttakingvitaminsNOWto“vitaminload”

• Improvecurrentvitaminstatusandpreventdeficienciesfromoccurringduring1st 2weeksofyourpost-surgeryliquiddiet• Youmaycontinuetakingyourowncompletemultivitamin(solid,notgummy)orstartbariatricvitamins

• Tryoutbariatricvitaminsamplesprovidedinclass,youmaypurchaseatTLCfrontdeskoronline• Startingtoday:takeminimaldoseofaBariatricMultivitaminandCalcium

- BariatricAdvantageMultivitamin:1capsule(insteadof3)or1chewable(insteadof2)- BariatricAdvantageCalciumChews:1calcium(formen),2calcium(forwomen)insteadof3

• TakeanyothervitaminsthatwererecommendedbyyourPCPorbasedonlabs• Considerswitchingtochewable/liquidsoyoucancontinuetotaketheseaftersurgery

• Donotusegummyvitamins• Youcantakethesevitaminsuntilthedaybeforesurgery

TakeVitaminsBeforeSurgery– OnlyforRevisionPatients

• YoualreadyhadVBG,verticalsleeve,RNYbypass,duodenalswitch(DS)• TaketheALLofyourrequiredbariatricvitamins• BariatricMultivitaminswithIron,and1500-2000mgCalcium“Citrate”• NO:gummies,patches,liquidmultivitamins

• StarttakingALLYOURVITAMINSNOWgetbackontrackwithpropernutrition• Thiswillalsohelppreventdeficienciesfromoccurringduringthe1st 2weeksofyourliquiddiet“aftersurgery”

• TakeanyothervitaminsthatwererecommendedbyyourPCPorbasedonlabs• Considerswitchingtochewable/liquidsoyoucancontinuetotaketheseaftersurgery

• Youcantakethesevitaminsuntilthedaybeforesurgery

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• UnlimitedamountofClearliquids:Atleast64ozdaily

Pre-OpLiquidDiet:ProteinShakesandClearLiquids• Proteingoal60-100gramsdaily

• 3-5shakesdaily• “Ready-to-drink”proteinshakesordrinks• Proteinpowders

• Mixpowderwithice,water,0%-2%milk,unsweetsoymilk/nutmilk• DONOTUSEjuice/fruit/smoothies.Thisaddssugar,caloriesandbulk

• AlotofClearLiquids• Highproteindietscancauseconstipationandkidneystones• “See-through”liquids,anycolor• Nocaffeine(decafOK):caffeineisadiuretic• Nocarbonateddrinks(nosodas):increasepressureinchestfromgas• Lessthan50caloriesperserving,Lessthan5gramssugarper8ounces

• DONOTDRINK• SlimFast,Atkins,Ensure,Boost,Glucerna,CarnationInstantBreakfast,Herbalife,Shakeology,Advocare• Thesedonothaveenoughprotein,andmaybetoohighinsugar/fat• AvoidJambaJuice,SmoothieKing,Gatorade,fruit/veggiejuices

• Ifyoufeelnauseated• TryswitchingtoWHEYISOLATEPROTEIN(Lactosefree)insteadofWHEYCONCENTRATEPROTEIN• Or,tryavoidingwhey/milk,tryPLANTBASEDPROTEIN

• Lookforblendsofpea,rice,nuts,beans,seeds• IfyougetLightheaded/Headaches,makesureyougetenough:

• +64ozwater,+60gramsprotein• Drinkregular(notlowsodium)broth

ProductComparison– NotBariatricAppropriate

Pre-OpProteinShakeOptions>20gramsprotein,<5gramssugar,<5 gramsfat,<250caloriespershake

WheyConcentrate(containsmilkandlactose)

WheyIsolate(stillhasmilk,butislactose

free)

PlantBasedProtein

(nomilk andlactosefree)

PlantBasedProtein(milkfree)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/CreamyProteinSupplements

PremierProteinDrink16oz,90calories20gprotein1gcarbsWheyproteinisolateSucralosewww.premierprotein.com

NectarProteinPowder1scoop=23gprotein25calories,0gsugarAcesulfame-K,SucraloseWheyproteinisolateManyfruity flavorswww.bariatricadvantage.com

IsopureZeroCarbProteinDrink20oz,160calories40gprotein0gcarbwww.isopurecompany.com

Pre-OpClearLiquidOptions<50calories,<5gramssugarper8ounces,64ozormore!

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• Takevitaminswithfood(takethemwhenyoustartthepureedphase– Day15)

• Spreadoutallyourvitamins;Donottakethemalltogether!!• Keepdosesatleast2hoursapart• Maycausenausea,stomachaches,orburpsiftakenallatonce• Maycausemal-absorptionofnutrients

• IronandCalciumneedtobekeptseparate,atleast2hours• Avoidusingcaffeine(coffee,icetea,green/blacktea)anddairy(proteinshakes,yogurt,milk)withIron• Phytatesblockabsorptionofiron,calciumandzinc(grains,beans,nuts,potatoes)

• Consider soakingand“sprouting”thesefoodstobreakdownphyticacid

• For3monthspost-surgery,allvitaminsneedtobeinthisform:• ChewableorLiquid• Crushedtablet(orcutintosmallsizetofitthroughadrinkingstraw)• Approvedcapsule(designedforweightlosssurgery)

• Thesearedesignedtodissolvequicklyuponcontactwithheatandmoisture• NOTRECOMMENDED

• Vitaminpatches,“oneaday”vitamins,liquidmultivitamins (Tespo),pre-natals,children’svitamins,softgels(fishoil,VitaminD,etc.),hardtablets

• NOGUMMIESORGUMBALLS

Bypass/Sleeve/DSVitaminsRequirements• Allvitaminsthatyouarerequiredtotake,areforMAINTENANCE(tostayatnormallevels)

• Ifyouarelowinothervitamins,youwillneedtotakeadditionalamountsuntilyoure-drawlabsat3monthspost-surgery• Ex:LowVitaminD?YouwillneedtotakeextraVitaminDuntilwere-checkyourlevels• Anemic?YouwillneedtotakeextraIroninadditiontowhatisprovidedalreadyinyourMV

• VitaminD/FishOilwillneedtobeliquid/chewableforatleast3months• OurTLCfrontdeskofferschewableVitaminDandahighpotencyliquidfishoil

• Don’tlikethetasteofBariatricAdvantageoritistooexpensive?• CelebrateVitamins.comisanotherappropriatebrandtochoose• CALLMEandI’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• KeepseparatefromIron• Take2hoursapartfromIron(orMVwithIron)

• Calciumfromfoodcountstoo!

• 4.VitaminD3• 3,000to5,000IUdaily

• 5.Iron• Bypass/LoopDS:40-65mgperday• Sleeve

• 40-65mgdaymenstruating/anemic• 0-18mgfornon-anemicmen/women,post-hysterectomy

• 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• UltraMultiwithIron:

• Swallow3capsules/day

- OR-• AdvancedMultiEA(EnhancedAbsorption):

• Chew2tablets/day

• Bothoptionsinclude• completemultivitamin• 1000mcgB12• 3000IUVitaminD• 45mgIron

• StillneedCalciumChewyBites• 1500mgCalciumCitrate• 500mgx3daily• Keepcalcium2hoursapartfromyourmultivitamin

DuodenalSwitch/LoopDSVitamins

• UltraMultiwithIron:• Swallow3capsules/day

- OR-• AdvancedMultiEA(EnhancedAbsorption):

• Chew2tablets/day• Bothoptionsinclude

• completemultivitamin• 1000mcgB12• 3000IUVitaminD• 45mgIron• 10,000IUVitaminA• 30IUto150IU(atleast15mg)VitaminE• 300mcgVitaminK

• StillneedCalciumChewyBites• 2000-2500mgCalciumCitrate• 500mgx4-5daily• Keepcalcium2hoursapartfromyourmultivitamin• Foodcountstoo!

SleeveVitaminsMenstruatingorAnemicMen/Women• UltraMultiwithIron:

• Swallow3capsules/day- OR-• AdvancedMultiEA(EnhancedAbsorption):

• Chew2tablets/day• Bothoptionsinclude

• completemultivitamin• 1000mcgB12• 3000IUVitaminD• 45mgIron


SleeveVitaminsNonAnemiaMenorPost-Hysterectomy/NonAnemicWomen• BariatricAdvantageUltraMultiWITHOUTIron

• Swallow3capsules/day- OR-

• “CelebrateVitamins”MVSoftChews• Chew2squares/day• Doesnotcontainiron

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


Doyouknowwhichvitaminsyouneed??SurgeryType Multivitamin:ChooseOne AndalsogetabagofCalcium

GastricBypassUltraMultiwithIronx3- or-AdvancedMultiEAx2

Calcium ChewyBitesx3

DuodenalSwitch

UltraMultiwithIronx3- or-AdvancedMultiEAx2

Calcium ChewyBitesx4-5

Sleeve(Menstruating/Anemic)

UltraMultiwithIronx3- or-AdvancedMultiEAx2


Sleeve(Non-AnemicMen,PostHysterectomy)

UltraMulti WITHOUTIronx3- or-MultivitaminSoftChewx2


SampleVitaminScheduleChooseeitherOptionA(capsule),OptionB(chewable)orOptionC(softchew)

Time Breakfast Mid-Morning Lunch Mid-Afternoon Dinner Bedtime

OptionA

BariatricAdvantageUltraMultiCapsuleMultivitamin(withor

withoutIron)

BariatricAdvantageCalciumChewyBites

500mg


withoutIron)


500mg


withoutIron)


500mg

OptionB

BariatricAdvantageAdvancedMultiEAChewableTablet(containsIron)


500mg

BariatricAdvantageAdvancedMultiEAChewableTablet(containsIron)


500mg


500mg

OptionC

BariatricAdvantageMultiChewyBite(withoutIron)


500mg

BariatricAdvantageMultiChewyBite(withoutIron)


500mg


500mg

CelebrateMultivitaminSoftChew(withoutiron)

CelebrateMultivitaminSoftChew(withoutiron)

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

AdditionalSupplementsifneeded• BariatricAdvantageVitaminD3ChewableGels

• 1gel=10,000IU.Take1geldaily,or1geleveryotherdaytoget5,000IU

• BariMelts D31tablet=5,000IUwww.barimelts.com

• BariatricAdvantageIron• 29mgChewableIronPassionFruit:Carbonylironandferrousfumarate• 60mgChewableIronLemonLime:Carbonyliron

• Vitron Ctablet65mgCarbonylIron www.vitronC.com

• NordicNaturalsOmega3FishOil• ProOmega2000D2softgels=2000mgOmega3• ProOmega2000Jrchewable2softgels=1042mgOmega3• ProOmega-DXtra1tsp=2925mgOmega3• SoldatTLCclinic;www.nordicnaturals.com;WholeFoods/Sprouts/Vitamin Shoppe/Amazon

• Barlean’sliquid“FishOilOmegaSwirl”2tsp=720mgOmega3• AvailableatmostHEBgrocerystores;www.barleans.com;Amazon

• BariatricAdvantageB50Complexcapsuleand1000mcgB12melting tablets

• WellesseLiquidCalcium3Tbs=1500mgCalciumCitrateWalgreens,www.vitacost.com

• CitraCalCalciumCitratePetites(anydrugstore)• Willneedtocrushtablets• 6-8“petite”tablets=1400-1600mgCalciumCitrate

2MonthPost-SurgeryDietProgression• Youhaveanewstomach,youarelearninghowtoeatagain• Yourtastebudsmaychangesouseseasoningscarefully• Purpose:Graduallyintroducedifferenttexturesuntilbacktoeatingsolidfood• DONOTSELFADVANCEDIET/DONOTRUSHTHEDIET

• Causesunnecessarypainandleaksinyour stapleline• Examples:Clearliquidphase– Patientatefajitasandkielbasasausage.Endedbackinthehospital.

Fullliquidphase– Patientatesteakbecausehewascooking forhisfamily.Hiswifecalled911becausepatientthoughthewashavingaheartattack(chestpain).

• Day1- 2:Clearliquids– focusonhydration• Day3- 14/Week1-2:Fullliquids– startproteinshakesandsoups• Day15/Week3- 4:Pureed– startvitamins,“baby-food”texture• Week5- 6Soft,choppedmeatsandcookedveggies• Week7- 8:ChoppedSolids(MaintenanceStage)

• Duringthese2months:AVOIDRESTAURANTS(largeportions,highsugar,highcalorie)

AVOIDRESTAURANTSduringyour2monthpost-surgerydiet.

*4gramsofsugar=1tsp=1packetofsugar*

2weekPre-SurgeryLiquid Diet

SurgeryDay!Day1Clearliquids

Day2Clearliquids

Day3Full liquids

4 5 6 7

8 9 10 11 12 13 14

Day15Week3-4PureedStartvitamins

16 17 18 19 20 21

22 23 24 25 26 27 28

Week5-6ChoppedSoftSolids

Week7-8ChoppedSolids

DietCalendarFill inyourowndayssoyoucanseewhenyoushouldprogresstothenextdietphase

Protein shakesandclearliquids only

Day3-14:Protein shakes,soups,yogurtandpudding, novitaminsyet

Day15-28:mashedeggs,fish,beans;oatmeal,applesauce,vitamins

2weeksofchopped, softmeats,cookedveggies,peeledfruits

2weeksofdifferent kindsofchoppedmeats,chopped rawveggies,fruits withpeel

Day1-2:ClearLiquids• Day1:Dayofsurgery.Whenyouwakeupaftersurgery,nurseswillbringclearliquidtray• 2-4Tablespoonsevery15minutes;Startslowandtakesmallsipsalldaylong

• Verticalsleeve,gastricbypass,duodenalswitch:plantostayovernight• ESG:youshouldbedischargedhomesamedayassurgeryday

• Day2:Gohome.Resumeclearliquidsathome.Considerusingmedicinecuptopaceyourself.• Aimfor+64ozlowcaloriefluidsperday.Sameclearliquidsasthe“pre-surgeryclearliquids”• Clear/See-through,<50caloriesand<5gramssugar

• NoCaffeine.OKdecafcoffee/tea,herbaltea.Nocreamer• Caffeine:diuretic, irritatingtoulcers,maycauseacidreflux,blocksIronabsorption

• Nocarbonation/nostraws• Chestpainfromtrappedair/gas

• NOGATORADE/G2(toomuchsugar)• Noproteinshakes/vitamins/solidfood!!!

Day3-14:Full(Thick/Milky/Opaque)Liquids

• Hydrationgoal:64oz• Stillsippingalldaylong• Carrywater/lowcaloriedrinkatalltimes• Decafcoffeeandtea

• FatfreecreamerandsugarsubstituteOK!• Nostraws,nosodas

• Proteingoal:+40-60grams/day• Resumedrinkingproteinshakes

• Proteinsupplement• +20gramsprotein,lessthan5gramssugar,lesthan250calories• Ready-to-Drinkproteinshakes:Premier,LaBrada LeanBody,MuscleMilk,etc.• ProteinPowders:Isopure,BariatricAdvantage,100%Whey,etc.

• Blendedwithice,water,0-2%milk/unsweetened soy/nutmilk• Donotaddfruit orjuice,donotmakesmoothies

FlavorfulProteinShakes• OKtomixin:• 2%milk,unsweetsoymilk,unsweetnutmilks• Spicesandextracts,unsweetcocoapowder• PB2(lowfatpeanutbutterpowder),sugarfreesyrup,decafcoffeecrystals

• NOTOKtomixin(addsextracalories,fatandsugar)• Blendedfruitstomakesmoothies,juice• Nutbutter,avocado

Day3-14:FullLiquids(continued)• ¼to½cuppermeal,5-6xday(orless)• Smooth andLowFatSoups

• Smoothsoups inabox• Lessthan10gsugarperserving• V8VegetableJuiceisalowersugaroption thantomatosoup• Lowfatcreamsoups

• Strainoutanybitsandchunks• Lookfor<5%totalfat• Example:Campbell’s98%FATFREEcreamsoups

• Homemadepureedveggiesoups,strained• Pureedcauliflower/butternut squash/pea,etc.• Seasoningsastolerated• Addwholemilkoradollop ofplainGreekyogurt forprotein

• Smooth Yogurt/SugarFreePudding• Nofruitpieces.Chooseflavorslikevanilla,lemon,etc.• PreferablyGreekstyleforextraprotein

• OikosTripleZeroGreekyogurt, YoplaitGreek100• Checkthelabel!!Keepsugarlessthan10grams

UnflavoredProteinPowdersMixintofoods/liquids toaddaboostofprotein

Unjury.comTLCClinic21gprotein90calories(recipesonline!)

BeneproteinNestleNutritionStore.comWalgreens1scoop(1.5Tbs)6gprotein25calories

IsopureGNCVitaminShoppe25gprotein100calories

EggWhiteProteinJayRobb.comHEB,Sprouts25gprotein115calories

BariatricAdvantage.comTLCClinic20gprotein80calories

*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

Week3-4:Pureed/Mashed• Starttakingvitaminsnow• Continuedrinkingplentyoffluids(+64oz)andmeetyourproteingoal(+40-60grams)• Fromthispointon,donoteatanddrinktogether ever

• Wait15minutesafterdrinkingtoeat/Wait30minutesaftereatingtodrink• ¼to¾cupportionspermeal.Startwith1-2Tbs.Aimfor<5-6smallmeals,every3-4hours• Seasoningsastolerated:salt/pepper/herbs/spices,mustard/mayo,sugarsubstitutes• ApplesauceTexturebeforeyoueat:MashedverywellwithforkorBlendinamini-foodprocessoruntilsmooth

• EatProteinFoodsFirst!!• Mashedsoftscrambledeggs(tryitwithhotsauce,ketchup,pinchofshreddedcheese)• Lowfatcottage/ricottacheese (addpureedfruitorsugarfreejam),lowsugarGreekyogurt• Mashed“white”fish:flounder,trout,tilapia,etc.(tryitwithlemonjuice,herbs)• Mashedsmoothtuna/cannedchickenwithbitofmayo.NOchunkyingredients:relish,celery,hardboiledeggs• Finelygroundleanbeef/pork/chicken/turkey/shellfish

• Grind1-2ozcookedmeatsinfoodprocessorwithbroth• Mashedsilkentofu

• Fiberfoods:• Mashedbeans(norestaurantrefriedbeans);hummus;mashedavocado• Unsweet applesauce,mashedfruits:bananas,peaches,pears• Mashedcooked veggies:sweetpotatoes,carrots,cauliflower,greenbeans

• Babyfoodfruit/vegOKifonlyblendedwithwater• Plaininstantoatmeal(cinnamon,Splenda,vanillaextract),grits (shreddedcheese, 1tspbutter),creamofwheat,Malt-O-Meal

Pureed/MashedAppropriateFoods

PortablePureedFoodstotakeonthego!

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

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• Continue+64ozhydration,+40-60gproteinandvitaminsdaily• ½to¾cuppermeal,5-6smallmealsevery3hours• Soft/easytochew,shredorbreakapartintosmallchunkswithfork• Fromthispointon,allyourfoodsneedtobechopped into“tipoffinger”size• Eatproteinfirst.Eatproteinwithallmeals/snacks(Thiscanprevent“dumping”)• Proteinfoods

• Shreddedskinlesschicken,chopped turkeymeatloaf,tenderpotroast,baked fish/sashimi(no rice)• Avoiddrychickenbreast,grisly/chewywell-donesteaks,dryporkchops

• Eggsanystyle(Hardboiled eggsareOK)• Stringcheese,Babybelcheese,lowfatcheeseslices• Chopped thindeliturkey,ham,chicken, roastbeef• “Soft”Nuts:walnuts,pecans,cashews,peanuts, slicedalmonds

• Starchyfoods• High fibercrackers,branflakes(+3gramsfiberperserving).NOBREAD/RICE!• Beans,quinoa,peeledchoppedsmall/sweetpotatoes• Chopped, CookedFork-TenderVegetables

• Choppedsoftbroccoli,carrots,cauliflower,zucchini,etc.• Finelychoppedcooked stringyveggies(greenbeans,spinach)• Noraw,nosaladsyet

• ChoppedPeeledFruit• Citrussegments(remove“membrane”)• Choppedberries,chopped grapes(noneedtopeel)

StuffedAcornSquashRecipeIngredients:2acornsquash(pleasewashandscrubtheskintorinseoffanydirt)2-3Tbsoliveoil1smallonion,smalldiced3-5clovesgarlic,minced1boxcreminimushrooms,smalldiced1poundgroundturkey1tspItalianseasoningSaltnpepper1can15ozsizetomatosauceShreddedmozzarellacheeseDirections: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'lldepend onalmondbutterbrandsomearethinnerorthickerthanothers.)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- Eatproteinatallmeals- Avoidpoorquality/highfatmeats(hotdogs,SPAM,bacon,etc.)- Aimfor+60-80gproteindaily

2– 4TbsHighFiberStarch- Smallestfoodgroup(eattheselast)- Highfiberchoices:quinoa,choppedsmallpotatoeswithskin,peas,corn,beans,lentils

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!

Bestsourcesofprotein:Lean“quality”meats,eggs,dairy(lowfatcheese)

Howcanyouaddinmore?

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,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

AllmealsandsnacksneedPROTEIN!

Bestsourcesofprotein:Lean“quality”meats,eggs,dairy(lowfatcheese)

Howcanyouaddinmore?

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

Alcoholism• New“transferaddiction”tocopewithemotions• Avoidfor6months!!

• Excesscaloriesandsugar!(margaritas,sangrias,daiquiris,etc.)• Vitaminmal-absorption(blocksBvitamins)• Leadstohighbloodalcohollevel• Youwillgetdrunkquicklywithsmallamounts(wine,liquors)• No“shots”orsugarycocktails• Beermaycause“foaming”atthemouthduetocarbonation• Tryathomefirsttoseehowmuchyoucansafelyhandle

• 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

VitaminandMineralDeficienciesØDeficienciesmaydevelopanytime!

ØPoordiet(noteatingawidevarietyofmeats,fruits/veggies,healthyfats,grains)ØNottakingvitamins,ortakingwrongtype

ØEasilyprevented.But,deficienciescangetworsewithoutannualcheckup!• B1(Thiamin)

• “Wernicke’sEncephalopathy”numbness/tinglinginhands/feet,irreversiblenervedamage,confusion,lossofbalance,blurryvision

• B1lossfromfrequentvomiting,B1malabsorptionfromexcessalcoholconsumption

• Osteoporosis• bonefractures,teethchipping/toothloss

• IronDeficiencyAnemia• fatigue,feelingcold,eatingice,“spoonnails”,paleeyes

• LowVitaminA• difficultyseeingatnight,nightblindness

• LowZinc• poorimmunity,poorcellrecovery(hairthinning,ridgesonnails)

FunctionsofFatSolubleVitamins:A,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(smoothies,creamysoups,juicyfruits)• DrinkingwithmealsExample: 5weekpost-sleeveatePaneraBreadcheesybroccolisoup.WenttoERduetopain,onmorphine from3pmto11pm

1½weekpost-sleevedrankcoffeecreamer.Rantobathroomwithdiarrhea12dayspost-sleevedrankmilkshake throughastraw.Spitupandhaddiarrhea.

• Lateonset(1-2hoursafter)• Solidsugar/fatfoods(desserts,friedfoods)Example: 2weekspost-sleeve, ate2slicesofBBQsausage.1hourlater:waterydiarrhea,sweating,flushing inface,bodycramps

3monthpost-sleeve, patientate1Frenchfry.45minutes later,feltstomachcramping,nausea,lightheaded

• Symptoms• Lightheadedduetobloodpressuredrop• Fatigue,tired,sleepy• Faintingduetobloodsugardrop(insulinspike,reactivehypoglycemiaduetohighsugar/highcarbintake.Pleasebalanceallmeals/snackswithBOTHproteinandhighfibercarbs)

• Stomachcramping,rapidheartrate,hotflashes,sweating,diarrhea

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:

• SmoothMoveTea1cupatnight.CaffeinefreeteawithSenna,anaturalgentlelaxative,availableatmostpharmacies;stimulatescolontocontractandpushstoolthrough(stimulantlaxative)

• MiraLAXpowder1capfuldissolvedinto8ozwater,taken1-2xdaily.Cleardissolving/tastelesspowderabsorbswaterintocolontosoftenstooltopasseasily(osmoticlaxative)

• PROBIOTICS:• Anyover-the-counterbrandissafetotry(Align,Culturelle,etc.)Youcanopenupacapsuleandmixtheprobioticpowderintoanynon-dairyfoods(applesauce,oatmeal,etc.)

• TherearemanydifferentstrainsofbacteriathatmayhelprelieveGIissues.BariatricAdvantagehasachewableprobiotic(ChewableFloraVantageProbiotic:availableatTLCofficeaswell)

• PHYSICALACTIVITY:• Dailywalkingforatleast30minutescanhelpstimulatebowelstomove

• RE-POSITIONYOURSQUAT:• SquattyPottytoiletstoolhelpstore-alignyourbowelswhileyousitonthetoilet,allowingforeasierpassageofstoolthroughyourcolon.

DehydrationisaBIGDEAL!Causes:notdrinkingenoughwater,vomiting,diarrhea

GOAL:+64ozdaily,atleast¼cup(2oz)ormore,every15minutesStayinghydratedisyour#1priorityalways,especiallyduringthesurgeryhealingprocess.Dehydrationcanhappenfast,andisveryseriousmedicalconcern.Youwillbere-admittedbacktothehospital forIVhydration.

SignsofDehydration• Mild:darkyellowurine,noenergy,drymouth,lightheaded,headache,strongodorinurine• Moderate:Lessurine,dry/sunkeneyes,poorskinelasticity,difficultywithconcentration• Severe:Nourine,possiblekidneyfailure,lethargic,vomitinganddiarrhea,shock

CARRYWATERATALLTIMES,EVERYWHEREandSIPALLDAYLONG!!

BariatricIVBag500mgThiaminFolicAcidVit/Min

StrategiestoStayHydrated• FocusonhydrationFIRSTbeforeproteinandvitamins

• Haveasourceoflowsugar/non-protein formofbeveragewithyouatalltimes.

• Proteindrinksdonotcounttowardshydration(proteincausesconstipation)• Determinehowmanydrinkingcontainersyouneedtogothroughinadaytoreach64oz.

• Ex:Mywaterbottleis30oz.Iwillneedtodrinkatleast 2perday.

• Useyourphonetohelpsettimers/reminderstodrink• 15minutealarms,smartphoneapps:Baritastichaswaterreminders

• Foreasierdrinkingandtocalmnausea• Switchupbeveragetemperature

• icecoldwithice,orroomtemperature,orhotherbaltea/hotbroth.Hot liquidsmayalsohelprelaxswelling.

• Switchupbeverageflavors• “spawater”infusedwithherbs(mint,basil)orfruits(citrus,berries,cucumbers),liquidflavorconcentratessuchasCrystalLight

• Switchupbrandsofwater!• “Brita”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

• Overthenextweeksandmonths,astheswellingreduces,youwillbeabletodrinkinglargeramounts.ItjusttakestimeJ

• ItisOKtodrinklarger(morethan2ozevery15minutes)andfasteramounts,insteadofsipping,ifyoufeelcomfortable

TrappedAirfromDrinking

• Duetopost-surgeryswelling(hiatalhernia),trappedairorgascancreatetemporary,butpainful,chesttightness• Avoidchewing/smackingongum• Avoidcarbonateddrinks(sodas,carbonatedwaters,etc.)

• Manypatientsavoiddrinkingsodaspermanently

• Avoiddrinkingthroughstraws• Youmaybeabletotoleratestrawsafter2months

• Considerusinga“sportstop”squirtbottletohelppreventsuckingintoomuchair.

HydrationSchedule

üCheckeachcupwhenyou’veconsumedatleast8ounces

• Yourgoalistodrink+64ozofwaterorlowcaloriebeverageeveryday.• Whateverydaycontainerareyouusing?Whatisthevolume?• Howmanycontainersdoyouneedtodrinkeveryday?• Whatcolorisyoururine?Itshouldbelightyelloworalmostclear.

Caffeine,Sodas,StrawsandGum• Avoidingthesefoods/devicesaretopreventcomplicationswhileyouarehealing• Caffeine

• Caffeineisadiureticwhichcancausemorefluidlosses=dehydration• Ifyoumustaddcaffeinebackintoyourdiet,makesureyouareabletodrinkenoughwatertostayhydrated(yoururineisclear)

• Caffeineblockstheabsorptionofminerals (calcium,iron)• Avoiddrinkingcaffeinatedbeverageswhenyoutakeyourvitamins.Keeptheseseparateatleast2hours

• Caffeinemayirritategastriculcersorstimulatemoreacidproduction• Youmayaddcaffeinebackifyoudonotfeelanyacidrefluxsymptoms

• Sodas,StrawsandChewingGum• Carbonatedbeveragescancreatealotofgaspressureintoyourpouch.ItwillNOTstretchyourpouch,butmaycausediscomfortinyourchest

• Drinkingthroughstrawscanleadtoswallowingalotofair,alsocreatingmorepressureinyourpouch.Also,drinkingthroughstrawscancausealargeamountoffluidstobeconsumedveryquickly.

• Chewinggummayleadtoswallowingmoreair,causingfullnessaswell• Youmaytrydrinkingcarbonateddrinks,usingstrawsandchewing(notsmacking)ongumwhenswelling isreduced,~2months

• Becarefulasthismaycausechestpainfromgas/airanddifficultyreleasingburps

GasandDiarrhea• Morecommoningastricbypassandduodenalswitch• 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)

MouthOdorandDryMouth• Maybeduetolowcarbohydrate/higherproteindiet,ketosis,dehydration,changesinyourmetabolism,ormedications

• Solutions:• Tryrinsingyourmouthwith:

• 1tsp.saltwith1cupwarmwater• 1tsp.bakingsodawith1cupwarmwater• BioteneDryMouthOralRinse:1Tablespoon,rinsefor30seconds,mayuseupto5xdaily

• Continuesippingonwaterorlemonwaterallday• Trysuckingonsugarfreelemondrops• TrysuckingonsugarfreecandiesmadewithXYLITOLtostimulatesalivaproduction• Avoiddrinkingcaffeine(tea,coffee)• Avoiddrinkingalcohol,andavoidusingmouth-washesthatcontainalcohol(Listerine)

• Maintaingoodoralhygieneasdrymouthcanleadtoworsebadbreath,fungusovergrowth(thrush)andcavities

• Thesesymptomswillimproveasyoubeginaddingmorevarietyoffoodsovertime

OtherComplications• ChestPain

• Swellingfromhiatalherniarepair(~2monthstoresolve)• Eatingtoolargeofabite,notchewingwell• Foodpreparedinatoughway(overcookedmeats/eggs)• Eatordrinktoomuchandtoofast;eating/drinkingtogether• Solutions

• Standupandwalkaroundaftereating,stayupright• Changetemperatures:icecoldliquidsorhotteamaybemorerelaxing• Considerdrinkingthrough“sportstop”waterbottletodecreaseairbubbles• Takeverysmallbitesandchewwell;donoteatanddrinktogether• Eatslowlytodetectearlysignsoffullness,donotovereat• Stopeatingthatfoodandre-trynextmonth.Perhapsyourstomachisstillhealing

• Nausea• Eatcold/roomtemperature/blandfoodswhichhavelessodor(applesauce,avocado,oats,crackers,broth)• Sniffingcoffeebeans,peppermintoiltogetridoffoulodors• Calmyourstomachwithherbaltea:mint/ginger/chamomileteas• Callourofficetodiscusswithsurgeonornursepractitioneraboutanti-nauseamedications(Zofran)

VomitingandSpittingUp• Sliming/SalivaPooling/Foamingofthemouth

• Foodgettingstuck• Notcuttingyourfoodintobitesizepieces• Notchewingwellenough,swallowingtoolargeofabite• Drinkingwithmeals• Overeating andtakingalargegulpofliquid• Solution:

• cutyourfoodintosmallpiecesBEFOREyoustarteating• eatmoistfood(notdry,over-cooked)• chewyourfoodintoamush(intoapureedtexture)beforeswallowing• allowsometimeinbetweeneatinganddrinking

• 15minutesafterdrinking, 30minutesaftereatingduring 1st 2-3monthsaftersurgery• 5minutesbeforeandaftereating,beyond3months, ifcomfortable

• VomitingonaweeklybasisISNOTNORMAL!• Callourofficetonotifysurgeon,dietitian,nursepractitioner

ComplicationsPost-Surgery• Tough/DryMeatscangetstuck

• Chickenbreast,drypork,chewysteak• Donotdrowninsauce!• Considerchangingfoodpreparation

• SlowCooker,poundthin/tenderize,choppedorslicethin• DarkmeatsOK!Removechickenskin

• Cooked/RawVeggies,FruitsandPeels• Alwayschoporslicethinlyforeasierchewing

• Example:ChooseAppleslicesinsteadofeatingappleoffthecore• Finelyshredsalads,rawleafygreensandrawveggies• Chopwellstringyveggies/cookedleafygreens

• Bread/Rice/Pasta/Tortillas:stayawayfor6monthsorlonger!• Expands,gooey=getsstuck.Also,highcalories!!• Highfibercrackers/ricecakesOK!

• Lookforfiber+3gramsperserving• Highfibercarbs:Beans,lentils,quinoa• Highfiber,lowcalorie,zerocarbalternatives:cauliflowerrice,zucchininoodles

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• Weightlossstallswillhappenthroughoutyourjourney• Somestallsmaylast~1month…andtheweightlosswillpickupagain– DON’TPANIC!• Assessyourlifestyle

• Haveyoubeencheatingwithhighcalorie,highsugarfoods/beverages,drinkingmorealcohol?• Chips,sweets,sodas/juice,bread/rice/pasta

• Areyoudiningoutmorefrequently?• Areyoueatinglateratnight?• Skippingmealsandsnacking/grazingmorefrequently?• Drinkingandeatingtogether?• Eating“sliderfoods”– saucy/liquidy/soft/mushyfoods

• easytoeatanddigestfoodswhichleadstoLARGERPORTIONS• Areyouexercisingaregularbasis

• Addweightlifting2xweek• Perhapsitistimetochangeupyourroutine,increasetheintensity

• Areyougetting64ozwater,+80gramsprotein,takingallyourvitamins?• FocusonQUALITYvs.QUANTITY

• Smallbitesoffastfoods….ISSTILLFASTFOOD!!!

• Ittakesabout1.5to2yearstoreachweightlossgoal

Howto“Cheat”withBariatricSurgeryBydrinkingwithmeals,orchoosingsoftfoods,foodswilllesslikelyget“stuck”andyouwillbeabletoeatmore.

Donotdrinkwithmeals. Avoidmixingliquidsandsolids• Forthe1st 2months

• wait15minafterdrinking,theneat• Wait30minaftereating,thendrink

• After2months,allow5mininbetweeneatinganddrinking• Avoidhavingadrinkingglassduringmeals

Aimtocutdownonliquid/pureedmealsstartingatWeek5• Trytoeatonlysolidfoods(mealsthatrequirechewing)• “Chewing”slowsyoudown,allowingforabettersenseoffeelingfull• Focusonfoodsthatrequirechewing,eatwithknifeandfork(notspoon)

• Eatwholefruit,notfruitpureesorfruitblended intoasmoothie/protein shake• Soups,mushyandsaucyfoods (mashedpotatoes,oatmeal,yogurt,etc.)donotrequirechewing• Ifmealsareeasytoeat(noneed tochew),youwilleatthemfaster,thenyoumayeatlargerportions• Tryyogurtwithchopped fruitandnutsandbranflakes

TrackYourProgressKeepalog/journal• Freemobileapps:MyFitnessPal,Baritastic,LoseIt!• CalorieKingnutritiondatabase• Freemobileappstologintake,setalertreminders,trackprogress

TipsforSuccess:• Usesmallplatesandutensils• 6inchplate(saladplate,breadplate)• babyspoons/cocktailforks/iceteaspoon• Helpstoportioncontrolandtakesmallerbites

• Stopeatingafter30minutes• Eatslowly,butstopeatingafter30minutes• Getupandwalkaway• Removefoodfromyoursight• Avoidnibbling/grazing

• Carrywaterandpackmeals/snacks• +64ozwater/lowcaloriebeveragedaily• +80gramsproteindaily

• Proteinatallmeals• Hardboiledeggs,Greekyogurt,stringcheese,nuts,delimeats• Proteinbars(<200calories,<10gfat,<10gsugar,>5gfiber,>10gprotein)• Proteinchips

TipsforSuccess:• Avoidhighfatandhighsugarfoods

• Overtime,youcanbuildupatolerancetohighfat/sugaryfoods.• Dumpingsymptomswon’tbotheryouanymoreifyoucontinueeatingjunkfood.• Weightregainhappenswith“Slider”Foods

• Highfat/sugary:Chips,candy,cookies,smoothies(blendedfruit),smothered/saucyfoods• Thesefoodsareeasytoeat,andeasytodigest=overeating!

• EatProtein1st,veggies2nd,saveminimalamountsofstarchesaslastfoodgroup• ThePowerofProtein

• Feelmorefullandsatisfied,energizedfortheday,helpswithweightloss,maintainmuscle

• PracticemindFULLeating• Areyoueatingnutritiousfoods?• Areyoueatingfast?• Areyousittingdowntoeat,withoutdistractions?

• Avoideatinginthecar,standingup,whileonthephone, infrontofcomputer,watchingTV• Didyoucutupallfoodintobitesizepiecesbeforeeating?Haveyouremovedyourdrinkfromthetable?• Slowdowntoeatbytakingonebiteatatime.Putdownyourforkinbetweenbites.• Cheweachbiteintoamush,swallowthisbite,thenpickupyourforkfornextbite.• Byslowingdown,youwillhaveabettersenseoffullness.• Ittakes~20minutesforyourbraintoregisterfullness

LifelongTipstoKeepinMind• Drink+64ozwaterdaily;Carrywatereverywhere(oktodrinkcaffeineifwellhydrated)• Consume+80-100gramsproteindaily:shakes,meats,eggs,dairy.(LoopDSneed+120gramsproteindaily)• Eatproteinwithallmeals.Aimfor20-30gramsproteinpermeal.• Startyourdaywith20-30gramsprotein(example:proteinsupplement forbreakfast)• Makeyourmealslast30minutes.Eatslowlybyputtingyourforkdown inbetweenbites• Sitdowntoeat,turnoffalldistractions(TV,car,computer, phone,etc.)• Pre-cutallyourfoodandcheweatbitetoamush• Donotdrinkwithmeals.Wait~5minutesbeforeandaftereatingtodrink fluids.• Makeallyourbitescountwithhighqualitynutrients. Don’t filluponuse-lesscarbs• Avoidhigh fatfoods:fried foods, creamysoups/sauces• Avoidhighsugarfoods:candy,desserts.Don’tdrinkyourcalories:juices,smoothies, sodas• Readlabels.Keepallyour foodslessthan10gramssugarperserving!• Nomindlessdaytimesnacking• Takeyourmultivitaminandcalciumeveryday• Exercise+5daysweek:+150minutescardioand+2daysofresistancetraining• Nonighttimesnacking!Giveyourself12hoursinbetweenyourlastmealandtomorrow’s firstmeal• Avoidfollowing “fad/trendydiets”thatarenotsustainableforthelong term

AfterSurgerySupport• ContinuetofollowupwithTLCSurgery!!• Accountability!!!• Weareheretosupportyou• Post-OpFollowUpSchedulewithSurgeon

• 2weeksandFirstBiteClass• 3months(labwork)– checkyourinsuranceforapprovedlabfacilities!• 6months(labwork)• 9months(labwork)• 12months(labwork)• Onceayear(labwork)

• FirstBiteClasswithDietitian• Thisisamandatorynutritionclassat~2weeksPost-Surgery• Discusslong-termpost-surgerycareandweightlossmaintenance

• ScheduleaPrivateNutritionConsultationat6monthspost

AfterSurgerySupport•Monthlypost-opsupportgroup• 1st Thursdayofthemonth,6pm• HermannDriveSurgicalHospital(FormerlyVictoryHospital)• 2001HermannDrive,Houston,TX77004• 1st floorconferenceroom• EnterviaHermannDriveSurgicalHospitalEmergencyRoomlocatedinrearofthebuilding

• Rotatingtopicsandspeakers• [email protected]

BariatricResources• www.tlcsurgery.com

• Recipes,handouts,thispacketisalsoavailableonline• Facebook:TexasLaparoscopicConsultants• CheckusoutonInstagram:tlcsurgery

• www.bariatriceating.com• Tips,recipes,proteinandvitamins• Facebooksupportgroups

• Theworldaccordingtoeggface.blogspot.com• Gastricbypassblog• Bentologybentobox

• Vitamins,ProteinandHighProteinFoods• BariatricAdvantage.com;CelebrateVitamins.com;BariatricFusion.com• Unjury.com• Ambarinutrition.com;BariatricChoice.com

• www.CalorieKing.com fornutrition information (freeapp:CalorieKing)• FreeCalorieTrackers

• Livestrong.com• Sparkpeople.com• FitDay.com• DailyBurn.com• LoseIt!iPhoneapp

• RecipeBooksonAmazon• “EatingWell AfterWeightLossSurgery”• “Recipes forLifeAfterWeightLossSurgery”• “FreshStartBariatric Cookbook”

ForadigitalcopyofthispresentationCheckoutourwebsite:www.tlcsurgery.com,hoveroverPATIENTRESOURCESandthenclickonNUTRITIONCLASS(Thisisaverylargefileandcannotbesentviaemail.Also,tohelpsavepaper,only1copywillbeprovidedtoyou)

DietCalendar2weekPre-OpLiquidDiet

SurgeryDay!Day1Clearliquids

Day2Clearliquids

Day3Fullliquids

4 5 6 7

8 9 10 11 12 13 14

Day15Week3-4PureedStartvitamins

16 17 18 19 20 21

22 23 24 25 26 27 28

Week5-6ChoppedSoftSolids

Week7-8ChoppedSolids

Endof2monthPost-OpDiet

Nutrition Class for Weight Loss Surgery Preparation · Nutrition Class for Weight Loss Surgery Preparation Lin Lin Shao, Dietitian [email protected] 713-493-7700 ... • Losing

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