Nutrition and Weight Loss Surgery

Donna Logan, RD, LDdonna@tlcsurgery.com

Maddie Orsak, MS, RD, LDmaddie@tlcsurgery.com

Objectives

• Preoperative protocol and liquid diet• Cover surgical procedures • Vitamin & mineral requirements Following bariatric surgery• Brief overview of postoperative diet progression • Common intolerances following surgery

Nutrition Protocol Before Surgery •Begin immediately •Daily multivitamin

•Maintain or lose weight • Avoid the “Last Supper Syndrome”

•Liquid Diet• Start 2 weeks prior to surgery

PreOp Liquid Diet • Low calorie, low carb meal plan to induce ketosis

• If you are diabetic, contact your physician monitoring your diabetes prior to starting the liquid diet. Your physician will need to provide recommendations to adjust your medications as needed.

•Benefits – • Reduces size of

liver for quicker, safer surgery • Additional weight

loss• Familiarity with

postoperative diet progression

Surgical Procedures

•Adjustable Gastric Banding •Sleeve Gastrectomy •RNY Gastric Bypass•Duodenal Switch (DS)

Adjustable Gastric Banding (AGB)

Why Supplement?

• Deficiency pre op• Restriction• Avoid certain

foods• maladaptation

Vertical Sleeve Gastrectomy (VSG)

Why Supplement?

• Deficiency pre op• Restriction• Maldigestion• Avoid certain

foods

Roux-en-Y Gastric Bypass (RYGB)

Why Supplement?

• Deficiency pre op• Combination• Restriction • Malabsorption• Maldigestion

• Avoid certain foods

Duodenal Switch (DS)

Why Supplement?

• Deficiency pre op• Combination• Restriction • Malabsorption• Maldigestion

• Avoid certain foods

Band Supplementation

• Calcium• 1,500 mg/day• Calcium citrate• Chewable with

vitamin D

• Elemental Iron• 30 mg

premenopausal women

• Bariatric Multivitamin• 100% Daily Value• 2 a day • Chewable

• B12

• Sublingual (350-500 mcg/day)

• Nasal spray (500 mcg/week )

• Intramuscular injection (1,000 mcg/month)

Bypass/Sleeve Supplementation

• Calcium• 1,000 mg/day• Calcium citrate• Chewable with

vitamin D

• Vitamin D3• 5,000 IUs daily

• Elemental Iron• 30 mg premenopausal

women• 18 mg men and post

menopausal women

• Bariatric Multivitamin• 100-200% Daily Value• 2 a day • Chewable

Until diet has progressed to soft

foods

• B12

• Sublingual (350-500 mcg/day)

• Nasal spray (500 mcg/week )

• Intramuscular injection (1,000 mcg/month)

Duodenal Switch Supplementation

• Calcium• 2,000 mg/day• Calcium citrate• Chewable with

vitamin D

• Vitamin D3• 5,000 IUs daily

• Elemental Iron• 30 mg premenopausal

women• 18 mg men and post

menopausal women

• Bariatric Multivitamin• 200% Daily Value• 3 a day (per bottle)• Chewable

with ADEK

• B12

• Sublingual (350-500 mcg/day)

• Nasal spray (500 mcg/week )

• Intramuscular injection (1,000 mcg/month)

Medications

• Discuss with TLC surgeons EVERY medication you are taking –• including over-the-counter and vitamin,

mineral, and herbal supplements• You may be told to postpone,

discontinue, or change the dosage of the medication• You may be instructed to change the

form to liquid or chewable• Do not make medication changes or

decisions without consulting the doctor

Postoperative Diet Progression • All procedures have the same progression• Clear liquids• Full liquids• Pureed• Soft foods to Maintenance

• Difference between procedures is how much time is spent on a stage

• Why?• Safety • Avoid leaks• Avoid nausea

and/or vomiting• Promote

healing

Postoperative Diet Progression • The diet progression is

gradual. Think about how you might progress with your nine-month old nephew…

TAKE BABY STEPS• Try new foods one at a

time and gradually replace liquid calories.

• If you aren’t progressing through the stages as expected, let us know.

Stage 1: Clear Liquids (Day 1-2)• 64 oz a day (48 oz minimum)

• Sip 1 oz over 10-15 minutes, then refill

• Sugar-Free• Caffeine-Free• Carbonation-Free

• Water• Sugar-free flavored

water (crystal light)• Decaffeinated

tea/coffee• Herbal tea• Sugar-free

popsicles• Sugar-free gelatin• Broth and bouillon

Stage 2: Full Liquids

•Gastric Band:• Days 3-7

• Bypass, Sleeve, DS: • Days 3-14

• Start vitamin and mineral regimen (Day 3)• If your are having difficulty taking all supplements, start

with the multivitamin (twice a day) and gradually add in all other supplements. You should be taking everything daily by 2 weeks postop

Goalhydration 64 oz/day &adequate

protein intake> 60 gms/day

Stage 2: Full Liquids• Clear liquids +• Skim milk or light soy milk• Protein shakes

• Use those recommended on the preop liquid diet• Bariatric Advantage or Unjury broth flavored powder• Isopure RTD

• Vegetable juice (low sodium)

• Strained cream soup (look for options low in fat & sugar)

• Sugar free pudding

Lactose Intolerance – common following sleeve, bypass, and DS. May experience gas, bloating, diarrhea. Switch to lactose free options – light soy milk, low fat Lactaid, Mootopia (HEB)

Stage 2: Full Liquids• Sip, sip, sip all day

long• Avoid temperature

extremes • extra hot or cold can

cause discomfort/spasms

• If you feel light headed, hungry, or dizzy… you may be dehydrated

• Feeling nauseated?• Sip fluids slowly• As your diet

progresses, take tiny bites (pencil eraser size), and chew well (apple sauce consistency)

• Dab peppermint oil on a handkerchief – smell when nauseated

Stage 3: Pureed • Gastric Band:• Days 8 - 21

• Bypass, Sleeve, DS: • Days 15 - 30

All foods previously allowed + food that is the consistency of baby food or applesauce

• Baby food • Add broth, skim milk,

or water to meats, fruit, and well cooked vegetables and puree/blenderize

• Light or plain yogurt• 0% Greek yogurt • 1% cottage cheese• Oatmeal • Fat free refried beans

Stage 4: Soft • Gastric Band:• After Day 21

• Bypass, Sleeve, DS: • After Day 30

Foods that you can mash with a fork and chew to the consistency of apple sauce

• Ground chicken or turkey breast • Dairy • low fat

• Eggs• Beans• Fish• Vegetables • over cooked

• Fruit • soft without peel,

canned

Preventing and Alleviating Possible Food Intolerances and Issues Following Bariatric

Surgery Handout

• Dumping Syndrome• Reactive Hypoglycemia• Nausea & Vomiting• Diarrhea & Constipation• Excess gas• Pain • Dehydration• Lactose intolerance

Preventing and Alleviating Possible Food Intolerances and Issues Following Bariatric

Surgery Handout

• Alcohol• Avoid for the first

year out from surgery or until you have reached goal weight

• Short term hair loss

Discuss in more detail at First Bite

Bring handout to class

• Tough meats• Raw fruit and

vegetables• Starchy foods

Tips for Success• Use small plates

and utensils• Avoid eating past

the point of fullness• Avoid skipping

meals

• Avoid drinking 30 minutes before, during, and 30 minutes after meal times • Continue to limit fats

and avoid concentrated sweets• Eat your protein first

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Online Course - Documentation• Go to www.tlcsurgery.com• Click on “Patients”• Then click on “Classes”• And finally, click on “Pre-Op Nutrition

Class”• Follow the instructions and submit the

form

IF YOU DO NOT COMPLETE THE FORM, WE WILL NOT HAVE RECORD OF YOUR CLASS ATTENDANCE.