Initial Weight Loss Surgery Nutrition Education

We recommend that you begin adapting Bariatric surgery requires a significant change in how and what you eat and drink. We recommend that you begin adapting now to prepare for these changes!

Band RNY Sleeve Duodenal Switch

How Your Diet Will Advance: Weeks One & Two: Liquids Only Week Three: Liquids and Semi-Solids Week Four – Month 3: Liquids and Soft Foods

Weeks 1 & 2: Liquids Only In hospital: Clear = ability to see light coming through Upon return home: milky or creamy consistency

Liquids Only (Weeks 1 & 2) Hydrating Fluids Protein Fluids Clear Liquid Protein (In hospital) Full Liquid Protein (Upon return home)

Choosing a Protein Supplement Choose a protein supplement with at least 15 grams of protein in an 8-12 oz. serving. Choose a liquid protein supplement with: 20g or less of total carbohydrates, 10g or less of sugar, and 10g or less of total fat.

Understanding the Nutrition Facts Label Start here < 10 g total fat < 20 g carbs < 10 g sugar ≥ 15 g protein

Drinking Schedule 1-2 oz. every 15 minutes Protein drink 1-2 oz. Fluid for hydration 1-2 oz. Fluid for hydration 1-2 oz. Fluid for hydration Following this schedule, it will take most people about 12-14 hours each day to reach their fluid and protein goals. ***Drinking too quickly or drinking too much at one time may cause pain or discomfort***

Nutrition Goals Fluid goal: at least 64 oz. hydrating fluid per day Protein goal: 60-80 g per day with band, sleeve, bypass 80-100 g per day with duodenal switch New “full” feeling: Pressure Tightness

Week 3: Semi-Solids and Liquids

Semi-Solids and Liquids (Week 3) Allowed Semi-Solids Semi-Solids to Avoid

Semi-Solid and Liquid Goals (Week 3) Take 20-30 minutes to finish each meal. Begin separating fluid from foods. Do not drink with meals! Take very small bites. Chew thoroughly. Eat a small meal every 3-4 hours. Measure out no more than ⅓ cup of semi-solid food.

Soft Foods, Week 4 to 3 Months post-op Group Soft Diet Class Fork Tender Foods Foods to avoid on the soft diet: Sugar sweetened, caffeinated, carbonated beverages Simple carbohydrates like chips, crackers, rice, pasta, and noodles Crunchy, rough foods Sticky or rubbery foods Tough, dry meats Skins and seeds of fruits and veggies Fried or high fat foods Whole milk products Please DO NOT START the Soft Foods phase until you have received instruction on the soft foods diet from a BSNC dietitian!

Meal Planning Do not skip meals! Breakfast 6:00 AM   2 egg whites 2 tbsp. salsa 1 oz. 2% cheese A.M. Snack 9:00 AM Two low fat string cheese sticks Lunch 12:00 PM Tossed salad with bib or butter leaf lettuce (1 cup of greens) 2 boiled eggs, chopped 2 tbsp. low-fat salad dressing P.M. Snack 3:00 PM 1/3 cup tuna salad with ½ cup cucumber slices Dinner 6:00 PM 1 black bean burger patty 1 slice bib lettuce 1 slice tomato 1-2 tbsp. light mayonnaise, mustard, ketchup 9:00 PM ½ cup Greek yogurt Meal Planning Plan to eat ⅓ cup protein every 3-4 hours Breakfast within 1 hour of waking Last snack or meal 2-3 hours before bed Do not skip meals!

Soft Foods Goals (Week 4 - 3 Months) 60-80 g protein per day (80-100 g duodenal switch) At least 64 ounces fluid per day Start meals with ⅓ cup protein, supplement w/ veggies Eat on a schedule - every 3-4 hours Take thumbnail size bites Chew foods to applesauce-like consistency Take 20-30 minutes to eat No drinking with meals (“30 minute rule”)

½ cup non-starchy vegetables This volume usually reached by 6-8 months post op. *Start Here* ⅓ cup or 3-4 oz. protein This volume usually reached between 10-12 weeks post-op. ¼ cup whole grain or starchy vegetables This volume usually reached between 1 – 1 ½ years post-op.

Dumping Syndrome only a side effect of RNY Gastric Bypass Early Dumping: Abdominal cramping and diarrhea Fatigue Sweating Rapid heart rate Decreased blood pressure Flushing Dizziness Shortness of breath Late Dumping: Shakiness Cold sweats Decreased blood pressure Headache Limit FAT and SUGAR Avoid fried, greasy, and sugary foods Follow the “single digit rule” <10 g of total fat and <10 g of sugar per serving

Alcohol All patients should avoid alcoholic beverages for one year after surgery.

Vitamins and Minerals You are on vitamin and mineral supplementation FOR LIFE! Bariatric Formulated vitamins All supplements and medications must be chewable or liquid for the first 30 days after surgery. A chewable or liquid B-Complex is the only vitamin recommended for the first month after surgery. On day 21 post-op: begin lifelong bariatric vitamin regimen RD will discuss during soft diet class

Liver Reduction Diet, 2-4 Weeks Prior to Surgery 2-4 Weeks Before Surgery Liquids only the week before surgery: 5 shakes per day

Things to Do Before Surgery Begin or continue an exercise program. Attend bariatric support groups, both before and after surgery. Maintain weight or initiate weight loss (follow instructions from surgeon). Discuss chewable or liquid medication options with PCP Begin planning a small meal every 3-4 hours Practice eating without drinking Practice sipping on fluid between meals – 64oz daily. Practice chewing foods to an applesauce consistency Practice eating with smaller utensils Practice mindful eating and try to eliminate distractions (ex. TV, phone, tablet) during meals

Purchase Prior to Surgery! Post-Op Essentials Purchase Prior to Surgery! Chewable or liquid B-Complex vitamin 1 bottle clear liquid protein – bring to hospital A variety of approved protein shakes A variety of approved hydration fluids

Download our patient app “BSNC” in the app store or Google Play! Begin self-education prior to surgery SurgeryNC.com – password: protein60 Download our patient app “BSNC” in the app store or Google Play!

Nutrition Follow-Up Case Managers: Brenda Piper Michelle Harvey Do I need to see the dietitian again before surgery? Contact your case manager! Case Managers: Brenda Piper Michelle Harvey Gabriela Cabeza Danielle Lowry Kristin Tosto