Nutrition and
Weight Loss Surgery
Donna Logan, RD, LD
Maddie Orsak, MS, RD, LD
donna@tlcsurgery.com
maddie@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
• 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)
• Calcium
• 1,500 mg/day
• Calcium citrate
• Chewable with vitamin
D
• Elemental Iron
• 30 mg premenopausal
women
Bypass/Sleeve Supplementation
• 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)
• 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
Duodenal Switch Supplementation
• 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)
• 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
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
• Why?
• Safety
• Avoid leaks
• Avoid nausea
and/or vomiting
• Promote healing
• Difference between procedures is how much
time is spent on a stage
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
Goal
hydration
64 oz/day &
adequate protein
intake
> 60 gms/day
• 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
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
• Feeling nauseated?
discomfort/spasms
• Sip fluids slowly
• If you feel light headed,
hungry, or dizzy… you may • As your diet progresses,
take tiny bites (pencil
be dehydrated
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
• Avoid drinking 30
the point of fullness
minutes before, during,
• Avoid skipping
and 30 minutes after
meals
meal times
• Continue to limit fats and
avoid concentrated
sweets
• Eat your protein first
Your success depends on you!
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.