Donna Logan RD LD donnatlcsurgerycom Maddie Orsak MS RD LD maddietlcsurgerycom Objectives Preoperative protocol and liquid d iet Cover surgical procedures Vitamin amp mineral ID: 912279
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Slide1
Nutrition and Weight Loss Surgery
Donna Logan, RD, LDdonna@tlcsurgery.comMaddie Orsak, MS, RD, LDmaddie@tlcsurgery.com
Slide2Objectives
Preoperative protocol and liquid diet
Cover surgical procedures Vitamin & mineral requirements Following bariatric surgeryBrief overview of postoperative diet p
rogression
Common intolerances
f
ollowing
s
urgery
Slide3Nutrition Protocol Before Surgery
Begin immediately Daily multivitamin
Maintain or lose weight Avoid the “Last Supper Syndrome” Liquid DietStart 2 weeks prior to surgery
Slide4PreOp 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 lossFamiliarity with postoperative diet progression
Slide5Slide6Surgical Procedures
Adjustable Gastric Banding Sleeve Gastrectomy RNY Gastric BypassDuodenal Switch (DS)
Slide7Adjustable Gastric Banding (AGB)
Why Supplement?Deficiency pre opRestrictionAvoid certain foodsmaladaptation
Slide8Vertical Sleeve Gastrectomy
(VSG)Why Supplement?Deficiency pre opRestrictionMaldigestion
Avoid certain foods
Slide9Roux-en-Y Gastric B
ypass (RYGB)Why Supplement?Deficiency pre op
CombinationRestriction MalabsorptionMaldigestionAvoid certain foods
Slide10Duodenal Switch (DS)
Why Supplement?Deficiency pre opCombinationRestriction Malabsorption
MaldigestionAvoid certain foods
Slide11Band Supplementation
Calcium1,500 mg/dayCalcium citrate
Chewable with vitamin DElemental Iron30 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)
Slide12Bypass/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
U
ntil diet has
progressed to soft foods
B
12
Sublingual
(
350-500
mcg/day)
Nasal spray
(
500 mcg/week
)
Intramuscular injection
(
1,000
mcg/month)
Slide13Duodenal Switch Supplementation
Calcium2,000 mg/day
Calcium citrateChewable with vitamin DVitamin D35,000 IUs daily Elemental Iron30 mg premenopausal women18 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)
Slide14Medications
Discuss with TLC surgeons EVERY medication you are taking –including over-the-counter and vitamin, mineral, and herbal supplementsYou may be told to postpone, discontinue, or change the dosage of the medicationYou may be instructed to change the form to liquid or
chewableDo not make medication changes or decisions without consulting the doctor
Slide15Postoperative Diet Progression
All procedures have the same progressionClear liquidsFull liquidsPureedSoft foods to MaintenanceDifference
between procedures is how much time is spent on a stageWhy?Safety
Avoid leaks
Avoid nausea and/or vomiting
Promote healing
Slide16Postoperative Diet Progression
The diet progression is gradual. Think about how you might progress with your nine-month old nephew… TAKE BABY STEPSTry new foods one at a time and gradually replace liquid calories.If you aren’t progressing through the stages as expected, let us know.
Slide17Stage 1: Clear Liquids (Day 1-2)
64 oz a day
(48 oz minimum)Sip 1 oz over 10-15 minutes, then refill Sugar-FreeCaffeine-FreeCarbonation-Free
Water
Sugar-free flavored water (crystal light)
Decaffeinated
tea/coffee
Herbal tea
Sugar-free popsicles
Sugar-free gelatin
Broth and
bouillon
Slide18Stage
2: Full LiquidsGastric
Band:Days 3-7Bypass, Sleeve, DS: Days 3-14Start 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
h
ydration
64 oz/day
&
a
dequate protein intake
> 60 gms/day
Slide19Stage
2: Full LiquidsClear liquids +
Skim milk or light soy milkProtein shakes Use those recommended on the preop liquid dietBariatric 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)
Slide20Stage
2: Full LiquidsSip, sip, sip all day long
Avoid temperature extremes extra hot or cold can cause discomfort/spasmsIf 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)
D
ab
peppermint oil on a handkerchief – smell when nauseated
Slide21Stage
3: Pureed Gastric Band:Days
8 - 21Bypass, Sleeve, DS: Days 15 - 30All 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
Slide22Stage
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
Slide23Preventing 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
Slide24Preventing and Alleviating Possible Food Intolerances and Issues Following Bariatric Surgery Handout
AlcoholAvoid for the first year out from surgery or until you have reached goal weightShort term hair lossDiscuss in more detail at First BiteBring handout to class
Tough meatsRaw fruit and vegetablesStarchy foods
Slide25Tips for Success
Use small plates and utensils
Avoid eating past the point of fullnessAvoid 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
Slide26Your success depends on you!
Slide27Online Course - Documentation
Go to www.tlcsurgery.comClick on “Patients”Then click on “Classes”And finally, click on “Pre-Op Nutrition Class”Follow the instructions and submit the formIF YOU DO NOT COMPLETE THE FORM, WE WILL NOT HAVE RECORD OF YOUR CLASS ATTENDANCE.
Slide28