SurgicalWeightlossProgram955 Main street, Suite G2A • Winchester, MA 01890

Programdietoverview

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POSTOPERATIVEBARIATRICDIET

• Stage1:WaterTrial

• Stage2:ClearLiquids

• Stage3:FullLiquids

• Stage4:PureedDiet

• Stage5:SoftDiet

• MaintenanceDiet

SurgicalWeightlossProgram955 Main street, Suite G2A • Winchester, MA 01890

Programdietoverview

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STAGES1&2:WATERTRIAL&CLEARLIQUIDSStage1:WaterTrialo Post-operativeday#1(inthehospital) o Startwithwater

o 1medicinecup(30mls)ofwater,thefirsthouro 2medicinecups(60mls)ofwater,thesecondhouro 3medicinecups(90mls)ofwater,thethirdhour

o Whenyouhavecompletedthewatertrailanddonothaveanynausea,thenyouwillprogresstoStage2:ClearLiquids

Stage2:ClearLiquids

o Post-operativeday#1&2(inthehospital)o Youwillreceive3or4medicinecupsofbroth,sugarfreeJell-Oand/ordilutedjuiceo Takeonebite/sipatatimeo Wait10minutesbetweenbites/sipso Ifyouarefull,stopanddonottakeanotherbite/sipo Yourgoalistolearntostopwhenfull,andnottakeonemorebiteorsipeventhough

youthinkyoucano Ifyouaredrinkingjuice,rememberitneedstobediluted(½juice,½water)tolimittheamountofsugaryouget

o Eatingordrinkinghighsugarfoods/drinksaftersurgery(suchaspuddings,icecream,cakespies,cookiesandsoda)maycauseaconditionknownas“dumpingsyndrome.”Dumpingsyndromeoccurswhenhighsugarfoodordrinkpassestooquicklyfromthestomachtothesmallintestine.Symptomsmayincludeacombinationofnausea,uncomfortablefullness,cramping,diarrhea,weakness,sweatingandfastheartrate.Ifthishappens,reduceyourintakeofsweetsandnotifyyourdoctor.Highsugarfoodsanddrinksarealsooftenhighincaloriesbutcontainfewnutrients,andthus,mayaffectthenutritionaladequacyofyourdietandyourabilitytoloseweight

o TAKETHEMEDICINECUPSHOMETOUSEFORMEASURING!!o Sometimesyoumayneedtocomebacktothethisclearliquidstageforashorttime

Remember:NOSTRAWSorCARBONATEDDRINKS—thiscancauseairtogetintothestomachwhichcanmakethesizeofthestomachlarger,andthiscanalsocausebloatinganddiscomfort

SurgicalWeightlossProgram955 Main street, Suite G2A • Winchester, MA 01890

Programdietoverview

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STAGES3&4:FULLLIQUIDS&PUREEDDIET

Stage3:FullLiquids(Refertosampledietsheet;upto400caloriesperday)

o PostoperativeDay#3-9o Proteinshakes(thesameasthoseusedbeforesurgery) o Skimmilko Fatfree/sugarfreeyogurt(NOFRUIT)o Fatfree/sugarfreepuddingo Sodium(Salt)FreeBrotho V-8Juice(LowSodium/Salt)o Addunflavoredproteinpowder(usingasaltshakertopreventlumpsofpowder)toeachitemthroughouttheday—theequivalentofoneextrascoop

o Useproteinpowderthataddsatleast20-30gramsofproteinPERDAYandnocarbohydrates

o Take2-3sipsatatimeYourstomachisthesizeofaneggor¼cup.o Wait10minutesbetweensipsDecreasedvolumeorspaceinyourstomach=restrictiono Drinkonecup(8ounces)ofanon-caloricdrinkbetweenmealsatalltimes

Stage4:PureedDiet(Refertosampledietsheet;upto500caloriesperday)

o PostoperativeDays#10-21o Proteinshakes(thesameasthoseusedbeforesurgery)o Pre-SurgicalandPost-SurgicalDietItemso PureedBabyFoods—chicken,meat,fisho PoachedorOverEasyEggso Creamed/StrainedSoupsmakewithSkimmilko Applesauceo MashedPotatoesmadewithSkimmilko PureedBabyFoods—FruitsandVegetableso CreamofWheatCereal(ThinnedwithSkimmilk)o Avoidchunks/solidfoods

BEGINTAKINGVITAMINSNOW—LiquidorChewableonly!

SurgicalWeightlossProgram955 Main street, Suite G2A • Winchester, MA 01890

Programdietoverview

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STAGE5:SOFTDIET&MAINTENCEDIET

Stage5:SoftDiet(Refertosampledietsheet/upto700caloriesperday)

o Postoperativeday#22-36o Proteinshakes(thesameasthoseusedpriortosurgery)o Pre-SurgicalandPost-SurgicalDietItemso PureedItemso Soft,Moist,DicedandGroundProteinItemso Separateyourfluidsfromyourmeals:

o 30minutesbeforemealso 30minutesaftermeals

o 4-6smallmealsperdayo 2litersoffluidormore(noliquidswithcaloriesexceptmilk)o Gritso OverEasyorPoachedEggso Nofruitswithseeds

MaintenanceDiet(Refertosampledietsheet/upto1000caloriesperday)

o Postoperativedays#36andthereaftero 2litersoffluidormore(noliquidswithcaloriesexceptmilk)o 3mealswith2snacks(nofatsadded)o Closelymonitorcaloriecounto Returntojournalingtoassureaccuracyofnutritionintakeo Includemoredailyactivity—onceclearedwithyoursurgeon,incorporatemorevarietyintoactivities

o Donotneedproteinshakes(unlessusingforconvenience)o Increasevariety—foods,fluids,andexerciseo Chew,chewandchew—30timesperbiteo MayaddPeanutButtertodiet

o Followservingsizeo Besttostartwithcreamystyle

OtherReminders:

*Nostraws/carbonateddrinks*Nobread/tortilla/pasta/riceorpopcorn*Noraw/driedfruit/nutsorseeds

*Nomeatwithgristle*Nostringyfoods,Nobreading/frying*Nocelery,broccoli,cornorcabbage

**TRYONLYONENEWFOODITEMATATIME

**

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VITAMINS: (Refer to Separate Sheet)

Pre-op: Integrate vitamins into your daily regime no later than your second month with the dietitian. It is important to maximize your nutrients prior to surgery. The addition of vitamins and supplements to your daily diet will help assist with enhancing your nutritional health. We will monitor these components post-operatively as well. At a minimum you will need to take a Multi-Vitamin with 1,000 mg of Vitamin D. See separate sheet for dosages.

Post-op: Since your food intake is greatly reduced, it is recommended that you take the necessary vitamins so that you will not develop a vitamin and/or mineral deficiencies. The most important supplements are the Calcium Citrate and Vitamin D.

• Take liquid, chewable or gel type vitamins for approximately 6 months post op, then you may resume your preferred choice of vitamins, such as soft chew vitamins. Please discuss with your physician or dietitian. You must continue taking the Calcium Citrate.

• Companies that market vitamins specifically for bariatric patients include, but are not limited to: Bariatric Advantage and Celebrate

• Multivitamins- Should include: 18 mg Iron, 400 mcg Folic Acid, 140 mcg Selenium, 3 mg

Copper and 30 mg Zinc.

• Over the counter options include, but are not limited to (Adult): o Centrum Adult Chewable- Take two a day for three months after surgery then reduce

dose to one a day.

o Chewable Flintstones Complete

o Chewable Mega Teen Multivitamin (available at GNC)

o Calcium Citrate (MUST BE CITRATE) — Take 1200 to 1500 mg of calcium per day to prevent calcium Deficiencies that cause bone disease. Take one tablet twice a day (one in the morning and one in the evening)

o Vitamin D3 — Take 3000 International Units (IU's) per day (Total amount in 24 hours). Check to see if your calcium supplement has any Vitamin D in it, if it does not have Vitamin D, then take one tablet twice a day (one in the morning and one in the evening)

o B12 — Take 500 mcg per day sublingual (under the tongue for better absorption)

SurgicalWeightlossProgram955 Main street, Suite G2A • Winchester, MA 01890

BariatricprogramDietInstructions

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VITAMINS MUST BE LIQUID OR CHEWABLE AFTER YOUR SURGERY! (Minimum of Three Months)

Vitamin Recommended Dose

Vitamins per day Gastric Sleeve

Vitamins per day Gastric Bypass

Multivitamin With Minerals

100 % RDA of Zinc and Iron

One One in the am One in the pm

(* at different times)

B-12 500 mcg One (* after the 3 month visit with surgeon)

One (* after the 3 month visit with surgeon)

Calcium Citrate/ Vitamin D

1200 to 1500 mg/day 3000

iu/day

Two or Three Chews — 500 mg/V-D

(* best to contain magnesium)

Two or Three Chews 500 mg/V-D

(* best to contain magnesium)

Biotin Optional One One

Elemental Iron 18 — 27 mg ^ To be determined To be determined

Protein 70 grams per day

70 grams per day 70 grams per day

Notes: • Must start v i tamins in l iqu id/chewable form after surgery. • Multivitamin should include the following: 18 mg Iron (Ferrous), 400 IU Folic Acid,

Selenium 140 mcg, Copper 3 mg, Vitamin K 120 mcg, and Zinc 30 mg.

• B-12 shou ld inc lude: Methy lcoba lamin and Cyanocoba lamin

• Do not mix Multivitamins containing iron with calcium supplements — take 2 hours apart.

• Best sources to purchase vitamins post-surgically: Bariatric Advantage and/or Celebrate Vitamins.