Surgery Connections Diet Class Preparing for Weight Loss

Surgery Connections Diet Class Preparing for Weight Loss Surgery Joanna Kriehn, MS RD

Liver Shrinking Diet • Preparing for your surgery – Follow this special diet for 13 days + 1 day of clear liquids • See page 12 and 13 in Care Guide

Liver Shrinking Schedule Liver Shrinking >>>>>>>>> Liver Shrinking Continued >>>>>>>>>>>>>>>>>> Liver Shrinking >>> Clear Liquid Surgery

Understanding the preparation diet

Menu Breakfast • One High Protein Drink (no more than 200 Calories and at least 12 grams protein) Lunch • One High Protein Drink (no more than 200 Calories and at least 12 grams protein) and • one small piece of fresh fruit (small apple, pear, peach, tangerine) Afternoon Snack – optional; avoid if you can • 6 ounces low fat, light yogurt or low fat, light yogurt smoothies (less than 90 calories, artificially sweetened) or ½ cup non-fat cottage cheese.

Menu continued Dinner • 4 ounces of lean turkey, chicken breast, ham, roast beef or fish baked, grilled or broiled • 1 cup of raw or cooked green vegetables OR ½ C of V 8 juice • Optional: 1 slice of low calorie whole grain bread OR 1 tablespoon potato, pasta, rice or beans Avoid: gravy, sauces (e. g. BBQ, cheese, butter, grease, salad dressing (“spritzer type salad dressing is ok), mayonnaise, ketchup, mustard, and peanut butter, fried and breaded foods Evening Snack- optional; avoid if you can • 10 baby carrots or ½ apple

Protein Shakes Breakfast and Lunch Boost Glucose Control Muscle Milk Light

Protein Shakes-other options Breakfast and Lunch Slim Fast High Protein Atkins Advantage

Clear Liquid Diet • 1 day before surgery • No solid foods • Calorie free, sugar free, carbonation free beverages • Sip on something all day • Pages 14 and 15 in care guide

Clear Liquid Diet- Protein Drink

Purchase Isopure at GNC -General Nutrition Center http: //en. wikipedia. org/wiki/File: GNCPromenad e. JPG

Purchase also at The Vitamin Shoppe • http: //www. vitaminshoppe. com/p/naturebest-isopure-rtd-zero-carb-mango-12 drinks/np-1154

Clear Liquid Diet • Most common items – Page 14 care guide Crystal Light

Avoid These Items …… When on the clear liquid diet

After Surgery • Strategic Advancement through the diet – Slowly introducing different foods – Pay attention to how you feel • Eat only until full, do not over fill pouch • Safe healing • Maximize weight loss

What to expect……. . • Dietary Expectations in the hospital • Sip 1 oz clear, sugar-free, carbonation free liquids every 15 minutes • Sample warm and cool liquids

Early Post-op Diet Phases Surgery Clear Liquids >> Full Liquids Clear Liquids >>>>>>>> Full Liquids >>>>>>>>>>>>>>>

Hydration • Potential Lack of thirst • Lack of hunger – 1 oz fluids every 15 minutes

Hydration, continued • Taste preferences • Add sweetener, lemon or crystal light

Early Post-op Diet Phases Surgery Clear Liquids >> Full Liquids Clear Liquids >>>>>>>> Full Liquids >>>>>>>>>>>>>>>

Full Liquid Diet • Week 1 and 2 after surgery for Lap Band • Week 2 only for gastric bypass and sleeve • 5 mini-meals per day – Eat slowly (30 chews) – Dime sized bites – 2 T of food or 4 oz liquid Per meal - 25 g protein/day

Full Liquid Diet Sample food options Fat free or low fat plain Greek yogurt Instant oatmeal or Cream of Wheat (made with ½ cup of skim or 1% milk) Smooth, cream soups (made with milk) Mashed potatoes (made with milk and 1 tablespoon melted shredded cheddar cheese) • Sugar-free pudding (made with milk) For a more complete list see page 17 in the care guide • • •

Full Liquid Diet Sample Drink options • Slim-Fast Low Carb Shake 8 grams of protein • Muscle Milk ready to drink 8 grams of protein* • Muscle Milk Light ready to drink 6 grams of protein* • Sugar-free hot chocolate (made with milk) 4 grams of protein • Skim milk or 1% milk 4 grams of protein • 1% Lactaid™ milk* 4 grams of protein* For a more complete list see page 17 in the care guide

Full Liquid Diet - Oatmeal Recipe -Cook 1 package of instant oatmeal with skim milk. Dish up 2 T of this cooked oatmeal and place in a small ramekin. Add an additional 2 tsp of milk and 1 tsp of protein powder. This will total: 3 g of protein for this mini meal.

Tablespoon(s) vs. ½ a cup of food

2 weeks after surgery 4 weeks after surgery

Measure your liquids. Full liquid diet, 4 oz per mini-meal If you eat or drink too much or too fast ………. .

Soft and Moist Foods • • • Weeks 3 -6 Eat 3 meals/day ¼ to ½ cup per meal Focus on protein, 45 g/day Take 20 minutes to eat – Small dime sized bites • Page 18 care guide

Soft and Moist Phase >>>>>>>>>>>>>>> Soft and Moist Phase >>>>>>>>>>

Soft and Moist Foods

Soft and Moist Sample Menu Breakfast: Chocolate & Peanut Butter Shake 18 g protein 1/2 scoop of Jay Robb chocolate whey protein powder + 2 oz skim milk + 1 T smooth peanut butter + 2 oz water and ice (if desired). Blend until smooth Lunch: Spicy Tuna Salad: ½ cup canned tuna in water + 1 tablespoon fat free mayo + lemon pepper Mrs. Dash + 1 teaspoon hot sauce Dinner: Cheesy Turkey Chili ½ cup canned Hormel turkey chili with beans + 1/8 cup Kraft 2% shredded cheddar cheese + Mrs. Dash southwest chipotle seasoning

Solid Foods • • • Weeks 7 and beyond Eat 3 meals/day ½ Cup to 1 Cup of food/meal Focus on protein, 60 g/day Take 20 minutes to eat – Chew foods well • Page 19 care guide

Solid Foods-Start eating 2 oz/meal then progress to 3 oz/meal 2 ounce beef (use 80% lean) 2 ounce of chicken = 14 grams of protein

Sample Meal- Solid Foods 1 Egg + 1 egg white 12 g protein 2 links of chix apple sausage 9 g protein

Solid Food Menu Time Food Choice Amount Morning Cottage cheese ¾ Cup total Lunch Lentil soup with ham 1 cup total Dinner Cheesy fish filet 3 ounces total Total Protein Ingredients Grams of Protein ¾ cup of low fat cottage cheese 21 ¾ cup of canned 18 lentil soup + 2 ounces of deli ham and sprinkled with cheese 2 ounces of 21 cooked white fish such as tilapia (seasoned as desired)+ 1 ounce of melted cheese on top 60

Protein First- Then what? • Protein first at every meal – Helps you to feel full and stay full – Slowly empty from pouch – Preserve muscle mass • Adding other foods – Cooked veggies Sautéed Kale & peppers – Canned fruits without sugar – Wait 6 months to add salad & raw veggies

Foods to Avoid • Sugar such as honey and agave • Fatty Foods • Scratchy foods – Celery, green beans, meat with gristle • Starches – Bread, pasta, rice, tortillas • Sticky foods – Gum or bread • Certain Beverages – Carbonation, alcohol, caffeine

Other Information • Vitamins – Roux en y gastric byass – Lapband – Vertical Sleeve Gastrectomy • Bariatric advantage vs. other brands • Common concerns after surgery – Changes in bowel habits – Dehydration prevention and treatment 38 October 30, 2020

Vitamins • Start about 2 weeks after surgery • Help prevent nutrition deficiencies • Start slow, not all at once 39 October 30, 2020

Vitamin overview RYGB • Morning: • Take a high potency multivitamin with minerals and at least 18 mg of iron in it. • Afternoon: – B complex, 1 tablet • Dinner: – Take 500 mg of calcium citrate that contains 100 IU of vitamin D • Bedtime: – Take 1000 IU of vitamin D 3 every day 40 October 30, 2020

Vitamins for Roux en y gastric bypass by Bariatric Advantage • • • 41 Morning: Chew 2 Bariatric Advantage multivitamins Take one Bariatric Advantage calcium supplement Dinner: Bariatric Advantage Vitamin B complex Chew 1 Bariatric Advantage iron table (18 mg) Bedtime: Take one Bariatric Advantage calcium supplement Take one Bariatric Advantage Vitamin D 3 (1, 000 iu) October 30, 2020

Vertical Sleeve Gastrectomy • Morning: • Take a high potency multivitamin with minerals and at least 18 mg of iron in it. • Afternoon: – Optional B complex • Dinner: – Take 500 mg of calcium citrate that contains 100 IU of vitamin D • Bedtime: – Take 1000 IU of vitamin D 3 every day

Lap Band • Morning: • Chew 2 Bariatric Advantage Vita. Band Chewable Multi Formula (see page 29 for product ordering information) • Afternoon: • Take one Bariatric Advantage calcium supplement • Bedtime: • Take one Bariatric Advantage calcium supplement • Take one Bariatric Advantage Vitamin D supplement 43 October 30, 2020

Vertical Sleeve Gastrectomy • Morning: • Chew 2 Bariatric Advantage Vita. Band Chewable Multi Formula • Afternoon: • Take one Bariatric Advantage calcium supplement • Bedtime: • Take one Bariatric Advantage calcium supplement • Take one Bariatric Advantage vitamin D supplement (1, 000 iu) 44 October 30, 2020

Taking your vitamins • Take at end of the meal • Add one new supplement each day • Chew well – Except for lozenges and sublingual 45 October 30, 2020

Lab Tests-checking your nutrition • Blood work recommended after surgery – – 46 3 months 6 months 1 year Annually after that October 30, 2020

Common Concerns Constipation-Prevention • Signs and Symptoms • Prevention – Walking – Sipping at least 64 oz fluids/day – Cheese 47 October 30, 2020

Common Concerns Constipation-Treatment • Day 3, no bowel movement – Walk – Water – Ducosate, 1 tablet 2 x/day – Melon, 3 bites/day – Avoid cheese Colace: brand name or generic name is Ducosate

Constipation Treatment continued • Day 4, no bowel movement – Walk – Water – Ducosate, 2 tablets, 2 x/day – Miralax, 8 oz per day – Avoid cheese – See page 30 in Care Guide

Constipation Treatment continued • Day 5, no bowel movement – Walk – Water, 64 oz – Ducosate, 2 tablets, 2 times/day • Add a glycerin suppository or fleets enema – Do not use more often than recommended on the label. • Miralax, 8 ounces

Constipation Treatment • 6 days, no bowel movement – ½ a bottle of magnesium citrate. Finish the bottle if no results • Call Kaiser to make an appointment, if no bowel movement in 7 days and have exhausted the above treatments – 303 -338 -4545

Hydration • 1 ounce of fluid every 15 minutes – Popsicles count towards fluid intake – Protein drinks count toward fluid intake • 64 ounces of fluid/day • Track your fluid intake

Detecting Dehydration • Common after weight loss surgery • Can result in hospitalization • Symptoms – – – – – feeling nauseous or vomiting or dry heaves dizzy or lightheaded dry sticky mouth or thirsty tired or sleepy irritable or anxious muscle weakness cracked lips fast breathing or fast heart rate constipation very dark-colored urine only 1– 2 times a day

Check Your Urine

Dehydration continued • If you have gone More than 2 days without drinking at least 32 ounces of fluid/day you are at risk for dehydration – Make same day appointment to be seen – Call KP main line at 303 -338 -4545 press option 1 for afterhours care options if calling outside of normal business hours – If you need to go to the Emergency Room please go to: Exempla St. Joseph Hospital (Denver) or Good Samaritan Hospital (Lafayette)

Meeting Fluid Needs Minimum 32 oz/day

Practice Work • • Care Guide Order Vitamins Purchase products for liver shrinking diet Complete Menus – Full Liquid – Soft and Moist – Solid Foods