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Nutrition and Weight Loss Surgery Donna Logan, RD, LD Maddie Orsak, MS, RD, LD

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Presentation on theme: "Nutrition and Weight Loss Surgery Donna Logan, RD, LD Maddie Orsak, MS, RD, LD"— Presentation transcript:

1 Nutrition and Weight Loss Surgery Donna Logan, RD, LD donna@tlcsurgery.com Maddie Orsak, MS, RD, LD maddie@tlcsurgery.com

2 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

3 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

4 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

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6 Surgical Procedures Adjustable Gastric Banding Sleeve Gastrectomy RNY Gastric Bypass Duodenal Switch (DS)

7 Adjustable Gastric Banding (AGB) Why Supplement? Deficiency pre op Restriction Avoid certain foods maladaptation

8 Vertical Sleeve Gastrectomy (VSG) Why Supplement? Deficiency pre op Restriction Maldigestion Avoid certain foods

9 Roux-en-Y Gastric Bypass (RYGB) Why Supplement? Deficiency pre op Combination Restriction Malabsorption Maldigestion Avoid certain foods

10 Duodenal Switch (DS) Why Supplement? Deficiency pre op Combination Restriction Malabsorption Maldigestion Avoid certain foods

11 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 B 12 Sublingual (350-500 mcg/day) Nasal spray (500 mcg/week ) Intramuscular injection (1,000 mcg/month)

12 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 B 12 Sublingual (350-500 mcg/day) Nasal spray (500 mcg/week ) Intramuscular injection (1,000 mcg/month)

13 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 B 12 Sublingual (350-500 mcg/day) Nasal spray (500 mcg/week ) Intramuscular injection (1,000 mcg/month)

14 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

15 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

16 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.

17 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

18 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 Goal hydration 64 oz/day & adequate protein intake > 60 gms/day

19 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)

20 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

21 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

22 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

23 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

24 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

25 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

26 Your success depends on you!

27 Online Course - Documentation Go to www.tlcsurgery.comwww.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.

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