Basics of Bariatric Basics of Bariatric NutritionNutritionMeghann Scholl RD, LDMeghann Scholl RD, LDClinical Nutrition SpecialistClinical Nutrition Specialist

Tampa General HospitalTampa General Hospital

Life-long Nutrition Life-long Nutrition GuidelinesGuidelines

4-6 small meals daily4-6 small meals daily Protein and Fiber at every mealProtein and Fiber at every meal

>60 gm protein daily>60 gm protein daily Sugar-free whey protein isolate powder Sugar-free whey protein isolate powder

Selection of Fiber-rich grains Selection of Fiber-rich grains Bread, Rice, Pasta: >3gm fiber per servingBread, Rice, Pasta: >3gm fiber per serving Cereal: >6gm fiber per servingCereal: >6gm fiber per serving

Practice “Survival Skills” dailyPractice “Survival Skills” daily

Survival SkillsSurvival Skills

1.1. Eat Protein FirstEat Protein First2.2. Eat Slowly (20-30 min/meal)Eat Slowly (20-30 min/meal)3.3. Chew Well (applesauce consistency)Chew Well (applesauce consistency)4.4. Avoid Fluids w/meals (15-30 min before/after)Avoid Fluids w/meals (15-30 min before/after)5.5. Avoid Concentrated SweetsAvoid Concentrated Sweets6.6. Omit high fat foodsOmit high fat foods7.7. Choose 1% of Fat Free dairyChoose 1% of Fat Free dairy8.8. Eliminate carbonated beveragesEliminate carbonated beverages9.9. Limit use of a strawLimit use of a straw

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Breakfast 1 Egg1 Egg1 sl WW 1 sl WW toasttoast

¼ cup ¼ cup oatmealoatmeal1 scoop 1 scoop vanilla vanilla protein protein powderpowder

6 oz protein 6 oz protein shake w/1%shake w/1%½ banana½ banana

1 Egg1 Egg1 sl WW 1 sl WW toasttoast

¼ cup ¼ cup oatmealoatmeal1 scoop 1 scoop vanilla vanilla protein protein powderpowder

½ cup LF ½ cup LF Cottage Cottage cheesecheese¼ cup ¼ cup pineapplepineapple

4 oz 4 oz omelette omelette w/veggiesw/veggies

Snack 1 apple1 apple1-2 Tbs 1-2 Tbs PBPB

1 oz nuts1 oz nuts½ apple½ apple

FF Plain FF Plain Greek YogurtGreek Yogurt¼ c blueberry¼ c blueberry

6 oz protein 6 oz protein shakeshake½ peach½ peach

1 apple1 apple1-2 Tbs 1-2 Tbs PBPB

FF Plain FF Plain Greek Greek YogurtYogurt½ peach½ peach

1 cheese 1 cheese stickstick½ apple½ apple

Lunch 6 oz 6 oz protein protein shakeshake½ banana½ banana

FF Plain FF Plain Greek Greek YogurtYogurt¼ c berries¼ c berries

½ c LS ½ c LS Minestrone Minestrone SoupSoup

FF Plain FF Plain Greek Greek YogurtYogurt½ peach½ peach

6 oz 6 oz protein protein shakeshake½ banana½ banana

½ tuna ½ tuna sandwich sandwich on WW on WW breadbread

6 oz 6 oz protein protein shakeshake½ apple½ apple

Snack 1 oz 1 oz cheese cheese 5 WW 5 WW crackerscrackers

6 oz protein 6 oz protein shakeshake½ apple½ apple

½ tuna ½ tuna sandwich on sandwich on WW breadWW bread

1 oz 1 oz cheese cheese 5 WW 5 WW crackerscrackers

½ turkey ½ turkey sandwich sandwich on WW on WW BreadBread

6 oz 6 oz protein protein shakeshake

1 oz 1 oz cheese cheese 5 WW 5 WW crackerscrackers

Dinner 3oz grilled 3oz grilled chickenchicken½ c ½ c zucchinizucchini

3oz grilled 3oz grilled chickenchicken½ c ½ c zucchinizucchini

1 c LS Split 1 c LS Split pea souppea soup4-5 WW 4-5 WW crackerscrackers

2-3 oz pork 2-3 oz pork chopchop¼ c ¼ c broccolibroccoli

¼ c WW ¼ c WW pasta pasta w/meat w/meat saucesauce

½ c Pot ½ c Pot RoastRoast

½ c Pot ½ c Pot RoastRoast

Why do they need Why do they need supplementation after RYGB supplementation after RYGB and/or Gastric Sleeve?and/or Gastric Sleeve?

The body is not able to absorb, use, or take in The body is not able to absorb, use, or take in enough nutrients to maintain good health.enough nutrients to maintain good health.

Stomach size is reduced so that very little food Stomach size is reduced so that very little food can be eaten at once. can be eaten at once.

Normal “mixing” that occurs in the stomach is Normal “mixing” that occurs in the stomach is reduced decreasing absorption of nutrients. reduced decreasing absorption of nutrients.

The small intestine that normally absorbs The small intestine that normally absorbs certain nutrients is no longer being used after certain nutrients is no longer being used after the gastric bypass procedure.the gastric bypass procedure.

SupplementationSupplementation - RYGB - RYGB & Gastric Sleeve& Gastric Sleeve

MVI (200% DV) – 1 dose twice dailyMVI (200% DV) – 1 dose twice daily Calcium Citrate + Vit. D (1500-2000 mg/day) – Calcium Citrate + Vit. D (1500-2000 mg/day) –

500mg three times daily500mg three times daily Vitamin B12 (1000 mcg/mo) – monthly injectionVitamin B12 (1000 mcg/mo) – monthly injection Iron from Ferrous Sulfate (18-27 mg/d) – Iron from Ferrous Sulfate (18-27 mg/d) –

preferably with MVIpreferably with MVI Twice daily during mensesTwice daily during menses

Timing is essential for max. absorptionTiming is essential for max. absorption

BreakfastBreakfast Snack LunchLunch Snack DinnerDinner

Bariatric Advantage Chewable Multivitamin Formula

1 1

Bariatric Advantage Calcium Citrate Chewy Bites

2 2 2

Bariatric Advantage Iron Chewy Bites (30mg)

1 1*

Note: Remember each column should be separated by 2 hours for maximal absorption.

*Twice daily for menstruating women

Supplement Break-down Supplement Break-down (example)(example)

Why do they need Why do they need supplementation after Lab-supplementation after Lab-Band?Band? You will only be able to consume food You will only be able to consume food

and fluids in small amounts. and fluids in small amounts. It is possible that you will not get all the It is possible that you will not get all the

necessary nutrients from the food you necessary nutrients from the food you eat, and will need to supplement vitamins eat, and will need to supplement vitamins and minerals.and minerals.

Supplementation - AGBSupplementation - AGB

MVI (100% DV) - BID x 3 months; then MVI (100% DV) - BID x 3 months; then q1 dailyq1 daily

Calcium Citrate (1500mg/d) - 500 mg TIDCalcium Citrate (1500mg/d) - 500 mg TID Optional B Complex – 1 serving/dayOptional B Complex – 1 serving/day

Supplement Break-down Supplement Break-down (example)(example)

BreakfastBreakfast Snack LunchLunch Snack DinnerDinner

Bariatric Advantage Chewable Vita Band

1 1

Bariatric Advantage Calcium Citrate Chewy Bites

2 2 2

Note: Remember each column should be separated by 2 hours for maximal absorption

For more information For more information contact:contact:

Meghann Scholl RD, LD/NMeghann Scholl RD, LD/N

mscholl@tgh.orgmscholl@tgh.org