Food Guide - Sleeve Gastrectomy - SmartShape · Avoid snack foods such as potato chips, tortilla...

Food Guide Sleeve Gastrectomy Program

Food Guide 2

FoodGuide

Nutrition.................................................................................4

EffectiveStrategiestoHealthyEating.....................................................9

I. ReadingFoodLabels9II. VisualizingYourPortion10III. PlanningYourMeals10IV. WeighingYourself11

LifestyleDiary:RulesandHints...........................................................12

Pre‐OperativeGuidelines.................................................................14

Pre‐OpRegimeSideEffects................................................................19

Post‐OperativeGuidelines................................................................20

I. Stage|ClearFluids22II. Stage|FullFluids23III. Stage|PureeFoods25IV. Stage|SoftFoods28V. Stage|SolidFoods30

Appendix1|Pre‐OpRegimenRecipes.....................................................31

Appendix2|Post‐OpRegimenRecipes....................................................40

Food Guide 3

SmartShape™FoodGuide

TheSleeveGastrectomyProgramisyourfirststeptoestablishingahealthierlifestyle.Itismeanttolengthenyoursatiety time,decreaseyourappetite, andhelpyoumanage thevolumeof foodyoueat. Thesechangesshouldhelpyoumake lifestylechanges thatwillultimatelyallowyou to loseweightandsustainweightlossleadingtoimprovedhealthandwell‐being.

In order to achieve your desired outcomes, you need to be a very active participant, includingcommitment to an altered relationship with food and eating, as well as modifications to yourbehaviorandactivitylevels.

The SmartShape™ Food Guide is meant to assist you, through this journey, by detailing basicinformation thatwill help you succeed. The guide covers instructions to follow before and afteryourprocedure,aswellasgeneralhealthyeatingrecommendationssuchashowtoreadnutritionlabels,trackyourlifestyle,adjusttheamountandtypesoffoodyoueat,howyoueatthemandmuchmore!

Please do not hesitate to contact the SmartShape team, our nurses, or dietitian if you have anyquestionsorconcerns. Wearecommittedtohelpingyouachieveyourweightlossgoalsinasafeandnutritionallysoundmanner.BestWishes,

TheSmartShape™WeightLossCentre

Food Guide 4

Nutrition

We want you to become familiar with basic nutritional information as you start your journeytowardsadaptingneweatinghabitsandmakingwisehealthyfoodchoices.

Nutrientsarerequiredbyourbodyeveryday.Thereare6maingroupsofnutrients:

1. PROTEIN–Proteinisanimportantpartofthestructureofallbodycells.Itisusedtobuildskin,hair andmuscle in your body. Your body needs a certain amount of protein each day to stayhealthy.Youwill see proteinsmentioned several times throughout the Food Guide becausewe reallywanttostresstheimportanceofthisnutrientineachandeverymealandsnack.Youshouldaimforatleast60‐80gramsofproteineachday.

MeasuringHints

1oz.ofmeatis=toaboutthreetofourtablespoonsofchopped/groundmeat.1oz.ofgratedorcottagecheese,tunaoreggsaladis=tofourtablespoons.

3oz.portionsizeofpoultryormeatis=thesizeofadeckofcards.

HowManyGramsofProteininSolidFoods

1oz.ofmeat=7gramsofprotein1eggwhite=7gramsofprotein¼cupeggsubstitute=7gramsofprotein

¼cupnon‐fatcottagecheese=7gramsofprotein¼tunafishinwater=7gramsofprotein1oz.low‐fatorfatfreecheese=7gramsofprotein6oz.low‐fatlightyogurt=8gramsofprotein

HighProteinIdeas

ChickenorTurkey

Pureedchicken/turkey‐trymixingitwithstrainedlow‐fatcreamsoupBaked,grilledorpoachedchicken/turkeybreasts

ThinslicedorshaveddelislicesMeatballsormeatloafwithgroundchicken/turkey

Chicken/turkeysalad

Food Guide 5

Fish

Baked,broiled,poachedorgrilledfishShrimp,imitationorrealcrab

FreshorcannedsalmoninwaterCannedtunainwaterandothercannedfish

Sushi

BeeforVeal(ExtraLean)Meatballs,meatloafandpottedbeefinleangroundbeef/veal

PorkShaveddelihamordeviledham

EggsorEggSubstituteScrambledeggsoromelet

HomemadeeggnogmadewithskimmilkDietcustardEggsalad

QuicheorfrittataDeviledeggs

Low‐FatDairyProducts

Milk(skimor1%)Yogurt(plainorlowfat)

Low‐fatcheesesincludingcottageorricotta

LegumesHummus

SmoothpeanutbutterDriedbeansorlentilsinsoups,stewsorchiliVegetarianorfat‐freerefriedbeansandtofu

AdditionalIdeasforAddingProteintoFoods

Consideraddingthefollowingitemstolowfatmilk,yogurt,cottagecheese,hotcereal,de‐caffeinatedcoffee/tea,lowfatcreamsoups,mashedpotatoes,casseroles,applesauceoreggs.

Non‐Fat/SkimMilkPowder1/3cuppowder=8gramsofprotein

EggWhitePowder

2tbsp=6gramsofprotein

NestleBeneprotein1scoop=6gramsofprotein

Food Guide 6

2. CARBOHYDRATES–Carbohydratesareessentialformentalandphysicalfunctioning.Theyarefoundinfoodsthatcontainstarch,sugarsandfibersuchasfruit,milkandalternativesandgrainproducts.Starchandsugarbreakdownintoglucose(thesugarinyourblood).Glucoseiswhatyourbodyuses for energy.Toomuch carbohydrate canmake it challenging tomanagehealthandweight,especiallyforthoselivingwithdiabetesorglucoseintolerance.Foods high in sugar and starch should be avoided due to their typically high caloric content.Consuminghighcaloriefoodscanresultinalossofcontroloverbloodsugar,slowerweightlossandevenweightgain.Youshouldavoidsoftfoodsastheydonotcontributetosatiety.Soft,highcalorie foods includecookies, cake, chocolate, icecream,doughnuts,brownies,pastries, frozenyogurt, sweetened cereals, fruit canned in syrup and regular jams, jellies & preserves. Highcalorieliquidsincludemilkshakes,fruitjuice,softdrinksandalcoholicbeverages.

3. FAT–Fatisusedtocushionbodyorgansandprotectnervecells.However,mostpeopleeatmuchmorefat, thanwhat isactuallyneeded.Ifyouarenotgettingenoughcarbohydrates, fatcanbechanged into glucose for your body to use for energy. Conversely, if you consume too manycarbohydrates,yourbodycanconverttheexcessintofat.

Avoideatingclosetothebone(i.e.ribs,thighs)orfatpadsaroundthebone Avoidfriedfoods‐removeallvisiblefatandskinfrommeatsandpoultry Avoid“fastfood”astheseareusuallyhighinfat Chooselowfatorfatfreeproducts Avoidhighfatdairyproductssuchaswholemilk,fullfatcream,cheeseorcreamsauce Avoidhighfatpastries,donutsanddesserts Avoidhighfatmeatssuchasbacon,sausageandhotdogs Limit added fats such as butter, margarine, lard, mayonnaise or spreads and saladdressing.Trythefatfreeorlowfatalternatives

Avoidsnackfoodssuchaspotatochips,tortillachips,cheesecurls

Youneedasmallamountof“healthyfats”daily(forexample,vegetableoilssuchasolive,canolaorsoybean;nutsornutbutteroravocado).However,evenhealthyfatsarehighincalories,sotheyneedtobelimitedtonomorethan2–3tbspperday.Somepre‐packagedorpreparedfoodscanbeveryhighinfat.Thesefoodswillbemuchhigherincalorieswhencomparedtolow‐fatfoodsinthesamefoodgroup.Unlessyoureadthelabels,youmaynotknowwhichfoodsarehighinfat.Werecommendyouchooseproductswithlessthan3gramsof fatper serving.You should control the amountof fat you are eating so that you cancontrolyourtotalcalories.Thefollowingchartlistseachcategorywithlow‐fat,medium‐fatandhigh‐fatfoods.*Proteins, carbohydrates and fat all contain calories. Calories can be described as ameasurementofenergy.Ifyoueatmorecalories(energy)thanyouuseinaday,yourbodywillstoretheextracaloriesas fat. Itdoesnotmatterwheretheextracaloriescome from,yourbodywillalwaysstoreextracaloriesasfat.

Food Guide 7

Low‐Fat Medium‐Fat High‐Fat

Food Group Choose these most often Choose these 1 ‐2 times a week

Choose these no more than 1 time per week

Breads, Cereals, Starchy Vegetables, &

Grains

Whole grain loaf bread, pasta, rice, potato, oatmeal, grits, cream of wheat, low‐fat boxed cereal, corn, peas, kidney beans, pinto beans, black beans, pretzels, bagels

Biscuits, cornbread, muffins, low‐fat crackers

Yeast rolls, dinner rolls, croissants, high‐fat crackers, potato chips

Milk & Yogurt Skim milk, fat‐free yogurt 2 % milk Whole milk, regular yogurt

Proteins Chicken, turkey, lean cuts of beef, lean cuts of pork, low‐fat hot dogs, turkey bacon, turkey sausage, low‐fat cheese, tuna fish packed in water, baked fish, egg whites, egg substitute, shellfish, fat‐free cottage cheese, wild game

Regular ground beef, mozzarella cheese, ricotta cheese, feta cheese, ribs, whole eggs

Sausage, salami, bologna, regular hot dogs, American cheese, cheddar cheese, Swiss cheese, bacon

4. VITAMINS– Vitamins do not provide calories for your body, but they are very important!Vitamins play a vital role in every chemical process that happens in your body. Even thoughvitaminscannotbechangedintoenergy,theyareusedbyyourbodytochangeothernutrientsintoenergy.ThevitaminsareA,Thiamin(B1),Riboflavin(B2),Niacin(B3),B6,B12,C,D,E,K,Folate,PanthothenicAcidandBiotin.

5. MINERALS–Likevitamins,mineralsdonotprovideenergy foryourbody,but theydoplayanimportantpart in your body’s chemical processes.Themaindifference betweenminerals andvitaminsisthatmineralsaresmallerandlesscomplexthanvitamins.Someofthemineralsthatyour body needs are Calcium, Phosphorous, Potassium, Sulfur, Sodium, Chloride, Magnesium,Iron,Zinc,Copper,Manganese,IodineandSelenium.

6. WATER/FLUIDS–Mostpeopleneedatleasteightcups(64oz.)offluideachday.Ifyoudonotgetenough, you will likely become dehydrated and can feel weak and tired or even hungry.Werecommendsippingonwateralldaybetweenmeals.Considerhaving1/3cupwaterevery15minutes.Suckingonicewillalsohelpcontributetofluidintake.

Fluidintakeisalsoimportanttomanagingdigestivehealthincludingdiarrheaandconstipation.Adequate water is essential to help rid the body of waste, maintain propermuscle tone andelasticityofyourskin.Most fluids should be calorie free such as water, Crystal Light, decaffeinated coffee/tea,unsweetened or artificially sweetened tea or broth. Please avoid all sugar sweetenedandcarbonatedbeveragesasitisasourceofhighcalorieswithlotsofgas.Werecommendthatyourestrictalcoholicbeveragesasmuchaspossiblesincetheydonothavenutritionalvalue,can

Food Guide 8

affectyourphysicalandmentalfunction,andcancauseweightgain,ulcers,gastritisand/orliverdamage. We also recommend limiting your caffeine intake to no more than 320mg/day(approximately three, 250mL cups/day) to avoid dehydrating effects and avoid interactionsbetweencaffeineandyourcalciumlevels.

Type of Nutrient Type of Foods Benefits

Calcium Milk, cheese & yogurt Builds healthy bones and teeth

Carbohydrate Breads and pastas Vegetables and fruits Honey Sugar Milk

Provides calories or energy ready for your muscles and your brain to use

Cholesterol Dairy products Egg yolks Meat

Helps to make hormones and cell membranes Bile salts are used to digest foods

Fat Butter, margarine, oils Baked goods Milk, cheese, ice cream, yogurt Processed meat Beef, pork, lamb, veal, chicken Nuts

Provides calories or energy Carries & stores vitamins A,D, E, K Insulates the body against the cold Cushions the skin, bones and internal organs

Fiber Whole‐grain breads, cereals and pastas

Vegetables, legumes and fruits

Aids in bowel regularity Reduces risk of colon cancer Lowers blood cholesterol

Iron Red meat Whole grain breads and cereals Raisins

Produces red blood cells that carry oxygen throughout the body

Protein Milk, cheese, yogurt Eggs Meat, poultry, fish Nuts, peanut butter Baked beans

Builds and repairs body tissues Minimizes hair loss

Trans Fat Hydrogenated fats Oils found in deep fried products and baked goods

None

Saturated Fat Butter, cheese, whole milk Sour cream Ice cream Lard, shortening Red meat

None

Sodium Sodium or salt occurs naturally in many foods but is also added to processed foods such as bacon, soups & potato chips

Balances body fluids Helps transmit electrical signals through nerves

Sugars Milk Fruits Vegetables Sweetened soft drinks Candies

Provides calories or energy ready for your muscles and brain to use

Vitamin A Carrots Squash Dark green leafy vegetables

Maintains healthy skin Provides good night vision

Vitamin C Citrus fruits Strawberries

Builds and maintains connective tissues Fights infections

Food Guide 9

EffectiveStrategiesforHealthyEating

Gettingtoyouroptimalhealthandweightlossgoalswillrequireeffortanddedicationonyourpart.Itisimportantthatyoufollowthedietaryguidelinesandoptimizehowmuchphysicalactivityyouget,toenhanceyourlongtermsuccess.Wehavedevelopedsomeideasforyoutoembraceduringyourjourneytoacquirenewhealthynutritionalhabits.I. READINGFOODLABELS

Knowinghowtouseinformationonfoodpackagingcanhelpyoumakebetterfoodchoicesandthusachieveahealthyregimen.Manufacturersprovideinformationinthreeways:nutritionalclaims, ingredientlistsandthenutritionfactstable.Allofthesetermsarebasedonstandardservingsizes.Noticethekeywordsfollowthesamepatternforeachnutrient: Freehastheleastamount VerylowandLowhavealittlemore ReducedorLessalwaysmeanthefoodhas25%lessofthatnutrientthanthe

referenceversionofthefood

Ingredients are listed in order from the most to the least. The earlier you see an unhealthyingredientlisted,thelesshealthythefoodproductisforyou.

%Daily Value: This figure indicates how this one serving fits into a 2,000-calorie diet. You should eat no more than 100% of each nutrient each day and no less than 100% for each vitamin and mineral every day. Quick guide: 5% or less is Low and 20% or more is high.

Fat: Pay attention to saturated and trans fats. Apart from the nutritional facts, search the ingredient list for words like “hydrogenated” or “partially hydrogenated” to determine if this product has trans.

The HIGHER the better (applies to everything in this section)

The HIGHER the better

The LOWER the better



Food Guide 10

FatFatscanbesaturated,unsaturated(i.e.monosaturatedandpolysaturated)andtransfats.Saturatedfats and trans fats are bad for your heart and should be avoided.We recommend looking in theingredients section for phrases such as ‘hydrogenated’ or ‘partially hydrogenated’ fat, oil orshortening, to learn if they are present in the food you are buying. Hydrogenated or partiallyhydrogenatedfoodslikelycontainatleastsometransfatandshouldbeavoidedwheneverpossible.SugarTo find out whether a sweetener has been added to a food (beyond sugars that are naturallypresent), look for terms such as sugar (sucrose), fructose, maltose, lactose, honey, syrup, cornsyrup,high fructosecornsyrup,molassesand fruit juiceconcentrate.High fructosecornsyrup isparticularlyharmfulbecauseitisstoreddirectlyasfatintheliverandisharmfultotheliver.II. VISUALIZINGYOURPORTION

Measureandweighyourfoodathomeasthiswillhelpimproveyourabilityto‘eyeball’portionsizes.

Learntovisualizeyourportions(seeboxbelow). Reviewyourchoicesandfoodrecordwiththedietitian.

Visualize Your Portions

Food Item Portion size Visual Object

Meat, Poultry, Fish (tuna / salmon) 3 Ounces Deck of Cards

Flesh White Fish (flounder / sole) 3 Ounces Checkbook

Olive Oil or Salad Dressing 1 Tablespoon Water Bottle Cap

Peanut Butter 2 Tablespoons 1 Shot Glass

Butter / Margarine 1 Teaspoon Postage stamp

Berries / Melon 1 Cup 1 Baseball

Pasta, cooked 1/2 Cup Computer mouse

Popcorn 3 Cups 3 Baseballs

Pretzels 1 Ounce / 1/4 Cup 1 Tennis Ball

Bread 1 Ounce CD Case

Hard Cheese 1 Ounce 4 Dice

III. PLANNINGYOURMEALS

It is recommended that you choose foods that are high in protein and fiber. Since youwilllikely be eating smaller amounts of foods, you need tomake sure you are getting the bestnutrition.Inaddition,proteinandfiberhelpkeepyousatisfiedforlonger.Protein– toget therightamountofprotein,youshould includeagoodsourceofproteinateachmealandsnack.Youshouldaimforatleastof60‐80gramsofproteineachdayasthiswillhelpfightoffhungerandmaintainnutritionstatus,musclemass,andallowyourbodytoburn fatwhenyou loseweight.Onceyoubegin to eat solid foods, it is recommendednot todrinkhighcalorieproteinshakesunlessitissuggestedbytheclinicstaff.Low‐fat–Youshouldhavenomorethanthreeservingsoffatduringyourmealseachday.Oneservingusually equals one tablespoon. If youuse a low‐fat versionof these foods, a serving

Food Guide 11

equalsonetablespoon.Ifyouuseafat‐freeversion,youdonothavetocountthatasaservingoffat.Thefoodsincludedinthisgrouparemargarine,mayonnaise,saladdressing,canolaoil,oliveoil,peanutbutter,creamcheese,sourcream,shorteningandbutter.Liquids–Limittheamountofcalorie‐containingbeveragesbecausetheydonotcontributetothefeelingofsatietyandmaypreventidealweightloss.Thegoalistochoosesatisfyingfoodstopreventyoufromovereatingatmealtime,aswellastominimizesnackingthroughouttheday.Thiswillnotonlyhelpyoutoloseweightbutalsohelpmaintainweightlossandhealth.HealthierDiningOutHabits–Research has shown that people tend to underestimate thequalityandamountoffoodconsumedwheneatingout.Weunderstandthisisanobstaclethatpatientsfaceeveryday.Therefore,werecommendpracticingportioncontrolathomesoyoucanbecomecomfortabledeterminingservingsizewheneatingout.Ifyoueatout,wesuggestyouavoidrestaurantsthatservedeepfriedfoodswithrichsauces.Itismuchhealthiertofindasaladbar,sandwichshoporasit‐downrestaurantwhereyoucancustomizeyourorder.Wesuggestyouordermealswithproteinandfibrecompliments.Anothergreattipistolookattheonlinemenuoftherestaurantinadvancetodetermineanyspecial requestsbeforeyouget to therestaurant.This iswill ableyou tomakewise choiceswithout feeling pressured. We recommend ordering baked, grilled or steamed foods asopposedtofriedfoods.Trytochoosethesmallestsizeregardlessofthepricedifferenceortrysharingyourmealwithafriend,ortakinghomehalfthemealforconsumptionthenextday.

IV. WEIGHINGYOURSELF

We recommend that you weight yourself once a week. Do not let the numbers on a scaledetermineyourmoodforthedayorweek.Remembertheyarejustguidelinesofhowyouaredoing,butnothowwedefinesuccess.Non‐scalevictoriesareveryimportantandgenerallyamoresatisfyingwaytomeasureprogress.Youneedtolearntoidentifythefeelingofsatietyandrespectthefeelingofnotovereating.Itisimportanttobepatientalongyourjourney.Losingweightisasteadyprocessthatmaybemoregradualthanyouwish.However,youwillbe losing weight and keeping it off in a very healthy way. Be patient with yourself andremember to also acknowledge and celebrate non‐scale victories including quality of lifeimprovements.

Food Guide 12

LifestyleDiary|Rules&Hints

Fromtime to time,youmaydecideorbeasked tocompletea lifestylediary. The informationyourecordinyourlifestylediarywillhelpyoudesignaneatingpatterntomeetyouruniqueneeds,bringforthpatterns,andassistyouinreachingyourpersonalself‐managementgoals.Studieshaveshownthatkeepingtrackofyourintakesandbehaviorforafewdayscanhelpyoumakesignificant,positivechangesinyourdietregime.

Writedowneverythingyoueatanddrinkfor3days.Trytochoose2daysduringtheweekand1dayontheweekendasourintakepatternstendtochange.Donottrytochangeyoureatinghabitsduringthe3daysof recordkeeping. Keep inmind thatnotalldays shouldbecompletely “typical”aswewanttoensureweanalyzeandreflectonevenourpoorestmanagementdays.

HelpfulHints1.WHEN:Indicatethetimeofdaytodeterminegapsoftimebetweenallintakes,beveragesincluded.2.HOWMUCH:Indicatetheamountoftheparticularfooditemyouate.Estimatethesize(2”x1”x1”),thevolume(1/2cup),theweight(2oz.)and/orthenumberofitemsofthattypeoffood(i.e.6pretzels).3.WHATKIND:WritedownthetypeoffoodANDfluidyouate/drank.Beasspecificasyoucan.Howwasthefoodcooked?Wasitgrilled,fried,steamed,orbaked?Wasitfresh,frozenorcanned?Ifyoueatbread, is itwhite,wheat,wholewheat, rye, honeywheatormultigrain? If youdrinkmilk, it iswhole,2%,1%,skim, soy,or ricemilk?Remember towritedown“extras” suchas sauces,gravies,saladdressing,mayonnaise,butter,sourcream,sugarandketchup.

4.ACTIVITY:List anyactivitiesyouweredoingwhileyouwereeating. Be sure to includewhere,suchasthecafeteriaatwork,yourdesk,aspecificroominthehouse,etc.Ifyouateatarestaurant,fast‐foodchainoryourcaryoushouldrecordthelocationaswell.Alsodetailwhoyouwerewith.Ifyouatebyyourself,write“alone”.Ifyouwerewithfriendsorfamilymembers,listthem.5.HUNGERandSATIETYSCALE:1=nothungry2=somewhathungry3=moderatelyhungry4=veryhungry5=starving

7.COMMENTS:Writedownyourmood,thoughts,andfeelingswhileyouwereeating‐forexample,sad, happy, bored, stressed and depressed. This is a very good and important way to track your“negative”emotionsandtriggers.Tips1.WRITEDOWNEVERYTHING:KeepyourdiarywithyoualldayandwritedowneverythingyoueatANDdrink.Apieceofcandy,ahandfulofpretzels,acanofsodapoporasmalldonutmaynotseemlikemuchatthetime,butoveraweekthesecaloriesaddup!

Food Guide 13

2.DOITNOW:Recordyoureatinganddrinkingasyougo.Donotdependonyourmemoryattheendoftheday.3.REQUESTFEEDBACKFROMYOURCARETEAM:Besuretoreachouttoyourcareteamifyouarefacingchallengesorareinterestedinfeedback;therefore,bringyourcompletedlifestylediarieswithyou/email/faxforyournextappointment.Exhibit1–DailyLifestyleRecordINTAKE TIME AMOUNT FOOD / BEVERAGE

DESCRIPTION ACTIVITY DURING

INTAKE HUNGER SCALE

SATIETY SCALE

COMMENTS

Breakfast

AM Snack

Lunch

PM Snack

Dinner

Evening Snack

Exhibit2–DailyLifestyleRecordforIndividualsLivingwithDiabetesINTAKE TIME AMOUNT FOOD / BEVERAGE

DESCRIPTION ACTIVITY DURING

INTAKE HUNGER SCALE

SATIETY SCALE

COMMENTS

Blood sugar before BREAKFAST:

Breakfast

Blood sugar (2hrsAFTER BREAKFAST):

Blood sugar before AM SNACK:

AM Snack

Blood sugar (2hrs AFTER AM SNACK):

Blood sugar before LUNCH:

Lunch

Blood sugar (2hrs AFTER LUNCH):

Blood sugar before PM SNACK:

PM Snack

Blood sugar (2hrs AFTER PM SNACK):

Blood sugar before DINNER:

Dinner

Blood sugar (2hrs AFTER DINNER):

Blood sugar before EVENING SNACK:

Evening Snack

Blood sugar (2hrs AFTER EVENING SNACK):

***Bloodsugargoals(subjecttochange):BEFOREMeals:4‐7mmol/LAFTERMeals:5‐10mmol/LExhibit3‐Endofdaychecklist.Checkofftheoptionsthatdescribeyourintakefortheday

Imaintainedabufferofatleast45secondsbetweenmyfoodandbeverageswallows Idrankeight,250ml,cupsoffluid Mealvolumeswerenomorethan1cup/1sideplate Ihadproteinateverymeal Ihadhighfibervegetables Iateatleastonefruit Ihadatleastonemilk&alternative

Itookmytimewheneating Ididnoteatcloserthantwohours Ididnotgetmyfood'caught'whileeating Ididnoteatfurtherthan4hours

Food Guide 14

Pre‐OperativeGuidelines

Inordertoprepareyouforyourprocedure,yoursurgeonwillprescribeSmartShape™Shakepriortosurgery. The amount of time youwill be on SmartShape™ Shakewill depend on your surgeon’sassessmentatthetimeofyourconsultation.Thepurposeofthepre‐opregimenistoreducethefatcontentandsizeoftheliverthroughtheprocessofketosis,notsimplyto loseweight.Byreducingthesizeoftheliver,itmakesthesurgerymoreefficientandsaferwithsignificantlyreducedrisksofcomplications.

1.SmartShape™Shakeisaspeciallydesigned,bariatric‐specificlowcarbohydrate,lowcalorie,highproteinmealreplacement.Theformulawascreatedtosupplyindividualswithdistinctandessentialdailyrequirementsofmacroandmicro‐nutrientstopreparethebodyforsurgery.Individualsshouldaimtoconsumeallthreeshakesdaily.

HelpfulTips

Werecommenddrinkingatleast64oz.(8cups)offluideachday Avoidsugar,milkorcreaminyourdecaffeinatedcoffeeortea.YoumayusecaloriefreesugarsubstitutessuchasSweet&Low,EqualorSplenda/Sucralose Eliminatesugarsweetenedcarbonatedbeveragesandlimittheconsumptionofsugar‐free,

carbonatedbeverages Eliminatealcoholintakeandavoidexcessivecaffeineintakeinanefforttoavoidpost‐op

withdrawalsymptomssuchasheadaches Begintoplanascheduleforyourmealtimesandfluidconsumptionthatreflectyourownpersonalschedule

TweaktheTexture&AddFlavortoYourProteinDrink

Sugarfreeflavorextractorspicescanbeadded(i.e.vanillaoralmondextract,cinnamonornutmeg) Sugar‐freecocoapowdercanbeaddedtoprovideachocolateflavor MakeaFrappuccinobyaddinginstantdecaffeinatedcoffeewithlotsoficetoyourproteinshakes Sugar‐freeCrystalLightpowder Ifyourdrinkistoosweetorthick,tryaddingmorewater Makea‘hotchocolate’bywarmingyourchocolateshakeupinthemicrowave/stovetop Makepopsicles,icechipsorafrozenslushytreatbyfreezingyourproteindrink Fortips,checkoutAppendix1for“ScrumptiousSmartShapeShakeRecipes”

3 daily servings

SmartShape™Shakes

250 calories specific low

glycemic index vegetables

Supplements regime

PRE‐OP MEAL PLAN

Food Guide 15

2.LowGlycemic IndexVegetables. In addition to three servings of shakes per day, you shouldincludeamaximumof250calories of specific, lowglycemic indexvegetablesperday.Thereareparticular portions specified for each glycemic vegetable that is ‘authorized’ for consumption, sopleaserefertothefollowingpagesforacompletedetailedlist.HelpfulTips

Avoidmeat,poultry,seafood,dairyproducts,grainproducts,fruits,broths,juicesincludingvegetablejuiceblends,salt,oilsandbutter Checkoutofthe“Pre‐OpRegimenRecipes”(Appendix1)inforrecipesandideasonhowtoflavoryourvegetables

3.SupplementRegime.Toensureyourbodyreceivescompletenutritioninthedaysleadinguptoyourprocedureandduringyourpost‐opstage,itishighlyrecommendedthatyouinitiatespecificsupplementseverydayfortherestofyourlife.Youshouldconsultwithyourdoctororpharmacistbeforestartinganysupplementtoensureitissafetodoso.

RECOMMENDED LIFELONG SUPPLEMENTS

VITAMIN / MINERAL

FORM

RECOMMENDED DOSE PRE‐OP

POST‐OP (DAYS 2‐20)

POST‐OP(DAYS 21 & BEYOND)

Prenatal multivitamin & mineral supplement Note: for males & females

Solid Chewable / Liquid

Note: Chewable / liquid prenatal is not

widely manufactured; if

unable to find, take a regular chewable /

liquid adult multivitamin in the

meantime

Solid Follow instructions on bottle

Vitamin B12 Solid Sublingual(under the tongue)

Solid 500 mcg per day to compliment food/fluid

contributions

Calcium Citrate Solid Chewable / Liquid Solid 500‐600 mg per day to compliment food/liquid

contributions

Vitamin D3 (also known as cholecalciferol)

Solid Chewable / Liquid Solid 1000 IU per day to compliment food/fluid

contributions

Gummysupplementsshouldbeavoided.Thequalityof gummysupplements is far less thanotherchewable/liquid forms, therefore it is suggested that individuals avoid gummy supplementsthroughouttheirweightlossjourney.4. Special Considerations. If you are an individual living with diabetes, please take specialprecautions when you start your pre‐operative regimen. You should check your blood sugar atleastfourtimesperdayandadjustyourmedicationsaccordingly.Duetothereducedcarbohydratecontent,werecommendthatyoureduceyourdiabetes/bloodsugarmedicationsbyapproximately½asastartingpointandnotifyyourphysicianwhomonitorsyou.

Food Guide 16

I.WHATISLOWBLOODGLUCOSE?

Whentheamountofbloodglucose(sugarinyourblood)hasdroppedbelow4mmol/L.Itisalsocalledhypoglycemia.Thisparticularbloodsugarlevelmayalsohaveyoufeeling:

Shaky,light‐headed,nauseous Nervous,irritable,anxious Confused,unabletoconcentrate Hungry Yourheartrateisfaster Sweaty,headachy Weak,drowsy Anumbnessortinglinginyourtongueorlips

Lowbloodglucosecanhappenquickly,soitisimportanttotakecareofitrightaway.Ifyourbloodglucosedropsverylowyoumay:

Becomeconfusedanddisoriented Loseconsciousness Haveaseizure

II.HOWDOITREATLOWBLOODGLUCOSE?

Ifyoucheckyourbloodsugarsandyouaretrulybelow4mmol/L,youmusteatordrinkafast‐actingcarbohydrate(selectonlyONE):

15gofglucoseintheformofglucosetablets(preferredchoice,forexample4DEX‐4tablets) 15mL(3teaspoons)or3packetsoftablesugardissolvedinwater 175mL(3/4cup)ofjuiceorregularsoftdrink 6LifeSavers®(1=2.5gofcarbohydrate) 15mL(1tablespoon)ofhoney

Note:Mostindividualsprefertoinvestintheglucosetabsastheyareconvenient,notatriskofearly expiry, require no planning, and typically contribute the least amount of calories tocorrectalowbloodsugarversusanalternativetreatmentoption.Wait10to15minutesandthencheckyourbloodglucoseagain.Ifyourbloodsugaris:

Stilllessthan4mmol/L,treatagain Greaterthanorequalto4mmol/L,consumeanutritiousintake(i.e.SmartShapeShakeTM)within60minutes

If youareencountering repeat lowbloodsugarepisodes, youshould followupdirectlywithyourhealthcarepractitionerwhomanagesyourdiabetesmedicationsasthereisanimmediateneedtoadjust the prescription. Also, be cautious and safe; do not operate heavy machinery afterexperiencinghighorlowbloodsugars.Also consider that corrections for blood sugars lows involves the addition of calories andcarbohydrates to your daily intake which will need to be compensated for through reducedvegetableconsumptiononthatday.

Food Guide 17

ServingandCaloriesofRaworSteamed/BoiledVegetables(Maximum250caloriesperday)

Please note thatmanipulating foods (i.e. cooking) alters their glycemic index and glycemic load values perserving;therefore,itisessentialthatyoutakeintoconsiderationhowmanyservingsyouplantoconsumeandwhethertheitemisinitsraworcookedform.Refrainfromcookingthingsintoasauce,pureeorsoupunlessyouaccountforthelargernumberofservingsthistypeofpreparationprocesswouldrequire.

VEGETABLE

SERVING SIZE CALORIES (KCAL) VOLUME WEIGHT (g)

CHOOSE MOST OFTEN (very low glycemic)

Alfalfa sprouts, raw 250mL 35 8

Artichoke, canned 1 heart 27 14

Arugula, raw 250mL 21 5

Asparagus, boiled 6 spears 90 20

Beet greens, boiled 125mL 76 21

Beet greens, raw 250mL 40 9

Bok choy, cooked 250mL 180 20

Bok choy, raw 250mL 74 10

Cabbage, boiled 250mL 115 14

Cabbage, raw 250mL 74 18

Celery, raw 1 stalk 40 6

Chili pepper, red/green 1 pepper 45 18

Chive, raw 100mL 20 6

Collards, raw 250mL 38 11

Cucumber, raw / peeled 250mL 126 15

Dandelion greens, boiled 125mL 55 18

Endive, raw 250mL 53 9

Garlic, raw 1 clove 3 4

Green onion, raw 1 medium 15 5

Lettuce, iceberg 250mL 76 11

Lettuce, romaine 250mL 59 10

Lettuce, spring mix 250mL 71 13

Mushrooms (white), raw 125mL (3 medium) 51 11

Okra, boiled 4 pods 44 8

Okra, raw 4 pods 48 16

Radish, raw 250mL 123 20

Rhubarb, raw 1 stalk 51 11

Snap beans (yellow / green), raw 10 beans 55 17

Spinach, boiled 125mL 95 22

Spinach, raw 250mL 32 7

Swiss chard, boiled 125mL 92 18

Swiss chard, raw 250mL 38 7

Turnip, boiled 125mL 82 18

Watercress, raw 250mL 36 4

Zucchini, raw 250mL 119 20

Food Guide 18

VEGETABLE

SERVING SIZE

CALORIES (KCAL) VOLUME WEIGHT (g)

CHOOSE LESS OFTEN (moderate glycemic)

Broccoli, raw 250mL 93 32

Brussels sprouts, boiled 4 sprouts 84 30

Brussels sprouts, raw 4 sprouts 76 33

Cauliflower, boiled 250mL 13 30

Cauliflower, raw 250mL 106 26

Celery, boiled 250mL 158 29

Collards, boiled 125mL 100 26

Cucumber, raw with skin 250mL 126 20

Dandelion greens, raw 250mL 58 26

Eggplant, raw 250mL 87 21

Kale, boiled 125mL 69 19

Kale, raw 250mL 71 35

Mushrooms (portobello), grilled 250mL 128 37

Mushrooms (white), cooked slices 250mL 114 30

Pepper (green), raw 250mL 157 31

Radish, boiled 250mL 155 26

Snap peas (yellow / green), boiled 125mL 66 23

Tomato, boiled 1 medium 123 21

Tomato, raw 1 medium 123 22

Turnip, raw ½ medium 61 17

Zucchini, boiled 250mL 190 29

VEGETABLE

SERVING SIZE

CALORIES (KCAL) VOLUME WEIGHT (g)

CHOOSE ONLY ONE ITEM FROM THIS LIST IN THE SERVING SIZES DETAILED BELOW OR LESS, AT A MAXIMUM INTAKE OF ONCE A DAY (high glycemic)

Eggplant, boiled 125mL 53 19

Kohlrabi, raw 125mL 72 20

Onion, raw 60mL 42 17

Pepper (green), boiled 125mL 72 20

Pepper (red / yellow), boiled 125mL 72 20

Pepper (red / yellow), raw 125nL 79 25

REMOVE VERY HIGH GLYCEMIC ITEMS COMPLETELY DURING PRE‐OPERATIVE REGIME

Onion, boiled Vegetable Juice Blends Soy Squash

Kohlrabi, boiled Peas Potato /Sweet Potato/Yam

Pickles

Fruit Carrot Beet Legumes

Beans Shitake and Brown Mushrooms raw & cooked Parsnip

Food Guide 19

Pre‐OpRegimeSideEffects

HUNGER

Ensuretoconsume:

All3mealreplacementsdaily;aimtohavethematregularmealtimes.Ifthisdoesn’twork,considermakingthe3mealreplacementsinto6minishakestakenevenlythroughouttheday

Upto250caloriesofthespecificvegetables Allsupplementsdaily Adequatefluidforhydration(2.5–3litersperday)

Donotconsume/nibbleonitemsoutsidetheregime,itmakeshunger(andotherpre‐opsymptoms)worseandmaysendyoubacktopre‐opday1.

Bepatient.Symptomssubsidewithin3–5daysofstartingregime.

Considernotpreparingfoodforothersand/oreatinginthecompanyofothers,ifyouthinkitwillbechallengingforyoutocontinueyourpre‐opregime.

HEADACHE

Ensuretoconsume:

All3mealreplacementsdaily;aimtohavethematregularmealtimes Upto250caloriesofthespecificvegetables Allsupplementsdaily Adequatefluidforhydration(2.5–3litersperday)

Bepatient!Symptomssubsidewithin3–5daysofstartingregime.

ConsidertakingregularTylenolforsymptomrelief.

Note:reducingyourcaffeineintakecancauseheadaches,whichisbesttackledinpre‐opthanpost‐op.

DIARRHEA

Giveyourbodytimetoadapttothisdrasticchangeindiet Optforavarietyofvegetablesastheyofferfiber,whichcanimprovestoolconsistency Increasefluidintaketomakeupforlossesandensureyoustaywellhydrated ConsidertheadditionofafibersupplementsuchasInulin(ie.Benefibre)orPsyllium(ie.

Metamucil).Ifyoucanfindit,weprefersugar‐freefibersupplements

NAUSEA

Donottakesupplementsormedicationsonanemptystomach Tryconsumingliquidshakewithsolidvegetables Remainuprightduringandafterintakes Considertakingnon‐drowsyGravoltohelpalleviatesymptoms

Food Guide 20

Post‐OperativeGuidelines

As you recover from your procedure, we recommend a gradual process where you will beintroduced to foods of increasing texture and density. These foodswill be introduced in definedstagesthatwillminimizetheriskofblockageandvomiting.Itisveryimportantthatyoufollowtheseguidelinesinordertogiveyourstomachtimetohealandachievemaximumbenefit.Inordertoachieveyourdesiredoutcomeandweightloss,youneedtobeanactiveparticipantinyourcare.Youshould intentionallychooseasmallerportionof food thanyouareused to.Carefulconsiderationshouldbegiventothequalityoffoodyoueattohelpyoufeelfull.Theoverall strategy is to feela senseof satietywith thesmallerportionof food.With theGastricSleeve,thegoalistoseehowlittleyoucaneatandfeelsatisfied,NOTtoseehowmuchyoucaneatbeforefeelingfull.“20:20”RuleIt isvery importantthatyoufocusonchewingyourfoodwellandeatingslowly.Eachbiteof foodshouldbechewedatleast20timesandeachmealshouldlastat least20minutes.Werecommendthat you eat protein‐based foods first to encourage the feeling of satiety, followed by vegetables.Savegrainproductsorstarchyfoodsfortheendofyourmeal.“45Seconds”RulePatientsshouldwaitaminimumof45secondsbetweenaswallowofsolidfoodandsipofaliquidbeverage. High calorie liquids such as ice cream,milkshakes, chocolate, fruit juices andalcoholwillprovideyouwithplentyofcalories,butwillnotcontributetosatiety.It is important tominimize the amount of air you ingest. Avoid using a straw, consumingcarbonatedbeverages,and/orgulping.VomitingByadheringtothisprogressiveplanweareconfidentthattheriskofvomitingcanbeminimized.

Food Guide 21

HelpfulItemsFormealpreparation Formedications

‐ Minifoodprocessor/foodchopper ‐pillcrusher‐ HandBlenderorthe“MagicBullet” ‐largepillcase(1weekworth)‐ Measuringspoonsandcups ‐ Smallkitchenscale

Otheritems‐ Babyspoon,cocktailfork(helpsyoutotakesmallbites)‐ Smalldecorativeplates(helpscontrolportionsandincreasestheeyeappealofthemeal)‐ Insulateddishorwarmingplate(helpskeepfoodwarmwhileyouslowlyenjoyyourmeal)‐ Sippingcup(forthosethathavedifficultybreakingthehabitofgulpingliquids)‐ Extraicecubetrays‐ Smallfreezerbags‐ Smallplasticcontainers

‐ TheFoodSaver™tovacuumpackfoods

AnticipatedProgressionScheduleIt is importantnot toadvancetheprogressionof foodfromonestagetothenexttooquickly.Itissafer to go slow in the advancement of your textures. Notice that we have providedrecommendations on the minimum & maximum amount of time to spend in each stage. Somepatients may take longer than others to progress from one stage to the next. If you have anyconcernsaboutbeingabletotoleratethenextstage,consulttheclinicstaff.

POST‐OP PROGRESSION TIMELINE

MINIMUM LENGTH OF TIME ASK YOURSELF:

“HAVE I BEEN TOLERATING?” DIETARY CONSISTENCY

Day 0

(Day of Surgery) ‐ Water ONLY

Day 1

(1st Day After Surgery) ‐ Clear Fluids ONLY

Days 2 – 7 YES: proceed to the “Puree Foods” stage

NO: extend up to Day 14 Full Fluids including SmartShape Shake

Days 8 – 14 YES: proceed to the “Soft Foods” stage

NO: extend up to Day 20 Puree Foods

Days 15 – 20 YES: proceed to the “Solid Foods” stage

NO: extend up to Day 28 Soft Foods

Days 21 & Beyond ‐ Solid Foods

Food Guide 22

DAYOFSURGERY

Forthefirst24hoursaftersurgery,pleasedrinkwateronly.

DAY1‐CLEARFLUIDS

START DATE: Day 1 – first day after surgery END DATE: Day 1

ClearFluids Low‐calorie,low‐acidfruitjuices,suchasapple,grapeorcranberry Decaffeinatedcoffeeortea Fat‐freeclearbrothorsoup Low‐calorieJell‐O(avoidpre‐made) Sugar‐freepopsicle

GOALS

• 1.5L ‐ 2L of fluid per day

• Sip fluids slowly & frequently throughout the day; aim for 30mL every 15 minutes

• This volume is meant to be a guide. You will learn quickly what feels comfortable & be able to gradually increase to 60 ‐ 80 mL per swallow during the first week after surgery.

GUIDELINES

• It is important that you drink adequate fluids after your procedure. Dehydration is a concern that can be prevented

• Continue frequently testing blood sugars

Food Guide 23

STAGE|FULLFLUIDS(INCLUDINGSMARTSHAPESHAKES)

START DATE: Day 2 ‐ after discharge, at home END DATE: Day 7 ‐ the full day

t FULL FL

LIST OF ACCEPTABLE FOODS DURING THIS STAGE

Food Group Examples

Vegetables and Fruit

Applesauce (unsweetened)

Vegetable juice (no chunks, low sodium)

Low acid fruit juices such as apple, grape, cranberry (low calorie,

diluted with water)

Milk & Milk Alternatives Milk/ fortified soy beverage (skim or 1%)

Classic yogurt (no chunks, low/non‐fat, thinned with milk or water)

Greek yogurt (non‐fat, thinned with milk or water)

Kefir yogurt (thinned with milk or water)

Yogurt drink (low fat)

SmartShape™ Shake

Pudding (no chunks, made with low fat milk, thinned)

Grain Products Cream of Rice, Cream of Wheat, Oat Bran hot cereal (thinned)

Fats and Oils Limit all (including butter, margarine, oil)

GOALS


• Sip fluids slowly & frequently throughout the day; aim for 60 ‐ 80 mL every 15 minutes

• Full fluid meals should not exceed 1/2 cup (125mL)

• Aim for at least 60 ‐ 80 grams of protein per day

GUIDELINES

• It is important that you drink adequate fluids after your procedure. Dehydration is a concern that can be prevented

• Look for opportunities to choose intakes that contain protein

• Consider using the SmartShape Shake as the fluid you choose to consume on 15 minute intervas

• Restart supplements (chewable / liquid); do not take on an empty stomach

• Regular testing of blood sugar

MEDICATIONS

•Re‐start solid prescription medication, small to medium size only (ie. TicTac or M&M size) on POST‐OP DAY 3

•Re‐start solid prescription medication, large size (ie. jujube size) on POST OP DAY 7

Food Guide 24

Miscellaneous Sugar‐free popsicles

Fat‐free, low sodium clear broth

Strained low fat cream soup

Beverages

Water or water with calorie‐free flavouring i.e. Crystal Light

Decaffeinated tea/coffee

Non‐carbonated, low calorie beverages

SAMPLE MENU

Meal Day 1 Day 2

BREAKFAST

8am

½ cup cream of wheat made “thin” with

skim milk**

½ ‐cup protein shake

MID‐MORNING

10am

½ cup protein shake ½‐cup unsweetened applesauce**

LUNCH

12pm

½‐cup cream of potato soup – strained** ½‐cup cream of mushroom soup –

strained**

MID‐AFTERNOON

2pm

½‐cup Greek style non‐fat yogurt ½‐cup vanilla yogurt drink

DINNER

6pm

½‐cup low‐fat cream of spinach soup –

strained**

½‐cup low‐fat cream of tomato soup –

strained**

EVENING

8pm

½‐cup high protein pudding** ½ ‐cup protein shake

** OPPORTUNITY TO ADD PROTEIN POWDER (SEE PROTEIN SECTION OF THIS GUIDE)

DehydrationAssistanceTool

When you are drinking enough fluids, your body is in balance and yoururinewill be a pale straw yellow color. When you do not drink enoughfluids,yourkidneystrytosaveasmuchwaterastheycanandcauseyoururinetobedarkerincolor(moreconcentrated).

Dark yellow‐brown urine is a sign that you are dehydrated and that youshoulddrinkmorefluidstopreventdehydration. Yourfluidintakegoal istomakeyoururine,nodarkerthanthecolor#3,onthechart.Thedarkercolors(4‐8)aresignsofdehydrationandmaycauseyoutobecomeill.

Note:Certainvitaminsandmedicationscanchangeyoururinecolor.Ifyouareconcernedabouthydrationlevels,contactyourphysicianforfollow‐up.

REFERENCE:http://www.hdgh.org/uploads/BariatricAssessmentandTreatmentCentre/dehydration%20urine%20colour%20chart.pdf

Food Guide 25

STAGE|PUREEFOODS

START DATE: Day 8 END DATE: Day 14 ‐ the full day

Youmaybeabletoeatthesamefoodstherestofyourfamily iseatingbyusingablenderorfoodprocessortopureeit.Everythingyoueatatthisstagemustbepureedorblended(nochunks).Ifyoueat foods that have not been pureed, it may cause an obstruction which can lead to seriouscomplications.Initially,youmaynotbeabletoeatalloftheitemsrecommendedinthemealsbelow.Listentoyourbody.Startwith1oz(2 tbsp)portionsandgradually includemorepureed foodateachmeal.Youshouldstopeatingifyoufeeldiscomfortorpressurewheneating.HowtoPureeYourFoodsStep1‐CutfoodintosmallpiecesaboutthesizeofyourthumbnailStep2‐Useicecubetraysasameasureof2ouncesoffoodStep3‐PlacefoodintheblenderStep4‐Addenoughliquid(fatfreechickenbrothorfatfreegravy)tocoverthebladesStep5‐BlenduntilsmoothlikeapplesauceorbabyfoodStep6‐Strainoutthelumps,seedsorpiecesoffoodStep7‐Usespicesandherbstoflavorfood HelpfulHints Removeseeds,skinsandfatbeforeputtingfoodintoblender Otherliquidoptionsincludewater,skimmilk,strainedlow‐fatsoup Ifyouhaveleftoverpureedfoods,tryfreezinginsingleservingportionsinicecubetraysandputthefrozencubesintoplasticfreezerbags

GOALS

• 2L ‐ 2.5L of fluid per day

• Sip fluids slowly & frequently throughout the day; aim to consume fluids every 15 minutes

• Puree meals should not exceed 1 cup (250mL)


GUIDELINES

• Progress to this stage when full fluids are going down without intolerance

• Consider baby food for ease and convenience

• Continue taking supplements (chewable / liquid) & frequently testing blood sugars

Food Guide 26

Veryleananddrymeatspureebetterbyaddingasmallamountof‘healthy’fat(margarine,oil,lightmayonnaise,gravy,etc.),orsmallamountsoflemonjuiceorlightmayonnaise Trypureedpeas,cannedbeansorsweetpotatoes Starchespureebetterwhenhot Riceandpotatoestendtopureeintoagummypasteandarenotrecommended Pastaornoodlesarenotrecommendedastheyarenotwell‐tolerated Freshvegetablesaremuchbetterthancanned Ifusingcannedfruit,drainfirstthenaddafewdropsoflemonjuicetohelppreventthemfromdiscoloring Addmeltedmargarineorasmallamountofliquidtohelpreachthesmoothapplesauceconsistency

LIST OF ACCEPTABLE FOODS DURING THIS STAGE

Food Group Food Choices

Meat & Meat Alternatives

Chopped soft poached eggs or scrambled eggs

Blend moist meat, poultry and seafood, Silken tofu

High‐protein shakes

Avoid: peanut or other nut butters

Vegetables & Fruits

Cooked soft or “overcooked” then blended

Unsweetened applesauce

Any fruit pureed without the skin (if from jar or can – don’t choose fruits in syrup)

Low sodium vegetable juice

Avoid: raw foods, corn, root vegetables such as white potatoes

Milk & Milk Alternatives

Low‐fat or non‐fat cottage cheese or ricotta cheese

Sugar‐free custards and puddings

Non‐fat, unsweetened/sugar‐free yogurt or frozen yogurt

Avoid: Chocolate milk, sweetened condensed milk, 2% or whole milk

Grain Products

Hot cereal – unsweetened oatmeal or cream of wheat (make with skim milk)

Avoid: pasta, bread, rice

Fats & Oils Limit all (including butter, margarine, oil)

Miscellaneous Foods

Blended soups (no chunks of vegetables/meat) – cream soups should be low‐fat

Egg drop or miso soup

Sugar‐free popsicles

Beverages

Water OR water with Crystal Light

De‐caffeinated coffee or tea

Non‐carbonated, low‐calorie beverages

High protein shakes

Avoid: sweetened fruit drinks, vegetable juices, sweetened iced tea, carbonated

beverages/soda, caffeinated beverages and alcoholNOTE:Allfoodandbeverageslistedinthefullfluiddietarystagearestillconsideredacceptableinthepureestage.AGE

Food Guide 27

3 DAY SAMPLE MENU

BREAKFAST 8am

½‐cup cooked cereal made with ½‐

cup skim milk

½‐cup unsweetened applesauce

½‐cup non‐fat cottage cheese

1 poached, chopped up egg

¼‐cup unsweetened applesauce

MID‐MORNING SNACK

½ ‐cup protein shake ½‐cup protein shake

½‐cup pureed fruit

½‐cup non‐fat Greek yogurt

LUNCH 12pm

½‐cup low fat yogurt

½‐cup pureed fruit

½‐cup blended vegetable soup ½‐

cup egg salad pureed

½‐cup blended lentil soup

½‐cup tuna salad pureed

MID‐AFTERNOON SNACK

½‐cup sugar free pudding make with

skim milk

1 sugar free popsicle

½‐cup low fat cottage cheese

1 sugar free popsicle

½‐cup low‐fat ricotta cheese with

cinnamon with ½‐cup protein shake

DINNER 6pm

½‐cup blended chicken or bean soup

½ ‐cup pureed fruit

2 oz soft fish pureed

½ cup pureed peas

½‐cup chicken soufflé pureed

½‐cup mashed sweet potato

Food Guide 28

STAGE|SOFTFOODS

START DATE: Day 15 END DATE: Day 20 ‐ the full day

Thesoftfoodstageoftenreferstoitemsthatareeasilycutor“broken”underthepressureofone’sfork;therefore,iteliminatesfoodsthatarehardtochewandswallow,includingrawfruitsandvegetables,chewybreads,andtoughmeats.

Thesoftfoodstagepreparesyouforsolidfoods.Initially,youmaynotbeabletoeatalloftheitemsrecommended in themealsbelow.Gradually increaseyourportionsas thedaysgoby. Ingeneral,youshouldbelimitedto1cup(1sideplate)offoodpermeal.Remembertochewyourfoodverywellandeatslowly.Foodchoicesshouldbelowinfat,caloriesandcarbohydrates.Eatingproteinatthebeginningofeachmealwillhelpyoufeelsatiated.Thebestsourcesofproteinareleanmeats,poultry,seafood,fish,eggs,dairyproducts,beansandlentils.Stopafter thedescribedportionandbegin tocheck fora feelingofsatiety(alsoreferredtoas theabsent feeling of hunger). If you feel full, pressure or any sense of discomfort you have probablyeatentoomuch.Thesearesignsthatyouareeatingtooquicklyoryourstomachisfull–slowdownyourpaceofeatingorstopeatingtherestofyourmealtoavoidvomiting.

GOALS


• Sip fluids slowly & frequently throughout the day; aim to consume fluids every 15 minutes

• Soft food meals should not exceed 1 cup (250mL)

• Implement "20/20" and "45 seconds" rules


GUIDELINES

• Progress to this stage when puree fluids are going down without intolerance

• Continue taking supplements (chewable / liquid) & frequently testing blood sugars

Food Guide 29

SAMPLE MENU

Meal Day 1 Day 2

BREAKFAST

8am

½‐cup cooked cereal made with ½‐cup skim

milk

¼‐cup unsweetened applesauce

1 egg

2 tbsp diced ham

1 tbsp low fat shredded cheese

1 small mashed ripe banana

MID‐MORNING

10am

2 tbsp hummus

¼ small whole grain tortilla

½‐cup low fat pudding

¼‐cup blueberries

LUNCH

12pm

½‐cup tuna salad with low‐fat mayo

¼‐cup low‐fat yogurt

¼‐cup drained canned pear

½‐cup mixed bean salad

¼‐cup cottage cheese

1‐drained canned peach half

MID‐AFTERNOON

2pm

½ cup skim milk

½ cup canned fruit

½‐cup low‐calorie hot chocolate made

with skim milk

DINNER

6pm

3‐oz steamed chicken

¼‐cup boiled broccoli

¼‐cup well cooked green beans

3‐oz steamed salmon

¼‐cup boiled cauliflower

¼‐cup mashed sweet potato

Food Guide 30

STAGE|SOLIDFOODS

SmartShape™ offers detailed educational sessions via webinar to expand on the recommendednutrition regime from this point forward. To review upcoming webinars and register, visit theEventsCalendaronourwebsite.Itisveryimportantthatyouchewyourfoodverywellandeatveryslowly.Initially,youmaynotbeable to eat all of the items suggested in themeals below.Gradually increase yourportions as thedaysgoby.Generally,youshouldbelimitedto1cup/1sideplateoffoodpermeal.AdditionalInstructions Introducesolidfoodsoneatatime. Limituseofbutter,margarine,mayonnaise,oil,gravy,cream,jam,jelly,honeyandtablesugar. Bake,boil,barbecueorbroilfood. Remembertotakeyoursupplements. Staywellhydrated.SuggestionsFirstTry… ThenTry…Casseroles–nohardvegetablesorcrunchytoppings Tendermoistmeats,slicedthinlyHomemadesoupsorwell‐cookedstews AnyotherfoodnotyettriedGroundmeatMincedchicken/turkeyCrackers

Note:Raw fruitandvegetablesandslicedmeatsshouldbetriedonlyafteryouaretoleratingawidevariety of foods. Keep your intake of root vegetables to aminimum as they tend to be higher instarchesandsugars.Someindividualsmayfindthefollowingfoodsdifficulttotolerate: Whitebreadorun‐toastedbread,pastaorrice Redmeatsuchasbeeforpork Drymeat,poultryorfish Skinofpoultryorfish Membrane,core,seedsorskinsoffruitsandvegetables Fibrousvegetables(corn,celery,asparagus,pineapple) Driedfruits,nuts,popcornorcoconut Friedfoodsorfoodshighinfat Chiliorotherhighlyseasonedfoods Reheatedormicrowaveablefoods

Eat threebalancedmealsperdayandavoid snackingorgrazingbetweenmeals,unlessmealsaregreater than 4 hours apart. If you are hungry betweenmeals, choose low‐calorie, nutrient‐densefoods.Yourdailyfoodintakegoalsare:

GOAL#1:6‐12ozofprotein‐richfoods GOAL#2:3‐4servingsofvegetables GOAL#3:1‐2servingsoffruit GOAL#4:2servingsofdairyproducts

Food Guide 31

APPENDIX1|Pre‐OpRegimenRecipes

Thepre‐opregimenisachallengingone!However,byvaryingthewayyouflavorandcookthelowglycemicvegetablesoutlinedintheFoodGuide,aswellasyourshakes,youcandeceiveyourmindandbodyintothinkingthatyouarehavinganassortmentofexquisiteindulgences!Althoughtherearepre‐determinedservingsizesoutlinedforeachrecipe,recallthatinasingleday,youarenottoexceedthe250caloriemaximumforyourtotalvegetableintake.Yourservingsizewilllookverydifferentthanwhattherecipedescribesasatypicalserving.Thegreatthingaboutmakingextraisthatleftoverscanbeusedinthefutureformealsandsnacks,whichsignificantlycutsdownontimespentplanningandpreparingfood.Theserecipesarequickandeasy,modifiedtomakeyoufeelsatiatedandwillsurelytantalizeyourtastebuds.Recipes within this resource have been developed, trialed and taste‐tested by your very ownSmartShape™careteam!

Food Guide 32

Chocolate & Orange Shake Cinnamon Apple Shake

INGREDIENTS 10 – 12 oz water Crushed ice

1 Chocolate SmartShape™ Shake 1 – 2 drops orange extract Blend until thick

INGREDIENTS 6 – 8 oz sugar‐free apple Kool Aid®

1 Vanilla SmartShape™ Shake 3 dashes of cinnamon Blend ingredients. Serve chilled

Raspberry Dream

INGREDIENTS 10 – 12 oz water Crushed ice

1 Vanilla SmartShape™ Shake Raspberry Crystal Light Blend until thick

Mint Chocolate

INGREDIENTS

1 Chocolate SmartShape™ Shake ¼ tsp mint extract 1 packet calorie‐free sweetener Blend and enjoy!

Chocolate Pudding SmartShape™ Shake Iced Tea

INGREDIENTS 2 ice cubes, crushed 6 – 8 oz water

1 Chocolate SmartShape™ Shake Blend until thick

INGREDIENTS 6 oz cold sugar‐free iced tea ½ tsp lemon juice

1 Vanilla SmartShape™ Shake Ice cubes to taste Whip in blender until frothy

Spiced SmartShape™ Shake

INGREDIENTS ¾ ‐ 1 ¼ cup cold water Spice, as desired (see chart)

1 SmartShape™ Shake packet, any flavor Pour cold water into shaker or blender. Add spice

and SmartShape™ Shake packet. Shake or blend until dissolved. Serve over ice.

Spice Vanilla Shake Chocolate Shake

Allspice pinch

Cinnamon pinch 1/8 tsp

Cloves pinch pinch

Ginger 1/8 tsp 1/8 tsp

Nutmeg 1/8 tsp 1/8 tsp

Recipe reference: Nestle Healthcare Nutrition Inc.

Scrumptious SmartShape™ Shake Recipes | PRE‐OP

Food Guide 33

Recipe reference: kitchenparade.com


Lemon Asparagus INGREDIENTS DIRECTIONS 1 pound asparagus Remove the lower half of asparagus spears and discard. 2 ‐4 tbsp lemon juice Place in vertical steamer over boiling water for 5 – 8 minutes. Pepper to taste Transfer to serving dish, toss with lemon juice and pepper. SERVING: 4


Roasted Cauliflower INGREDIENTS DIRECTIONS

4 cloves garlic, minced Set oven to 425˚F. ¼ tsp pepper Stir together all ingredients in a large bowl until cauliflower is uniformly coated. ½ tsp paprika Transfer to baking sheet in single layer (use a second sheet if needed). 1 head cauliflower, cut in small florets Roast for 30 – 45 minutes, stirring every 5 minutes for last 15 minutes. SERVING: 4


Curried Zucchini INGREDIENTS DIRECTIONS 1 tbsp garlic, minced Arrange zucchini in a single layer and sauté with water on medium heat. ½ ‐ ¾ tsp curry powder Add garlic and curry. Cover and let simmer for approximately 10 – 15 min. 1 pound zucchini, peeled, sliced in half‐in diagonals Add pepper and cilantro. Pepper to taste Cilantro, chopped SERVING: 2

Caraway Cabbage INGREDIENTS DIRECTIONS 1 small head green cabbage, finely sliced Steam or sauté cabbage in water. Turning occasionally, until limp but not brown. ¼ cup water Add remaining ingredients except parsley. 1 tsp pepper Cover for 30 minutes. 1 – 1 ½ tbsp caraway seeds Squeeze lemon juice on top, garnish with parsley for color and serve warm. 1 tsp onion powder 2 tbsp sucralose (Splenda®) Parsley, chopped fine (optional) ½ lemon (optional) SERVING: 6

Fresh Recipes & Beverages | PRE‐OP

Food Guide 34

Recipe reference: about.com

BBQ Grilled Vegetables in FoilINGREDIENTS DIRECTIONS GARLIC‐GINGER VINAIGRETTE DRESSING Preheat grill. ½ tbsp garlic Whisk vinaigrette ingredients in a large bowl. ½ tbsp fresh ginger (or ½ tsp ground ginger) Wash and drain vegetables then slice. Fresh ground pepper Add vegetables to vinaigrette, tossing to coat. ½ cup vinegar Tear two foil sheets about 11 x 18. Divide vegetables between the sheets; fold to create a pouch and seal tightly. VEGGIES Place on grill rack for 20 – 25 minutes until vegetables are cooked. 2 ribs celery, de‐veined, 1” pieces cut on a diagonal 8 brussel sprouts, cut into half 8 white mushrooms, sliced ½ head cauliflower (cut into florets) ½ head broccoli, discard stem, cut top of broccoli into florets ¼ head red cabbage, cut in small wedges SERVING: 5


Sublime Vegetable Stock INGREDIENTS DIRECTIONS ½ cup white mushrooms, chopped Oven roast or brown in a non‐stick pan with no additives other than water ½ cup celery (including leaves), chopped and your selection of low GI vegetables for about 5 – 7 min. Stir quickly. ½ cup zucchini, chopped Put vegetables in a pot and cover with water. ½ cup asparagus, chopped Bring water to a boil, then reduce heat and let simmer for 30 – 60 min until ¼ broccoli (including stems)** vegetables are soft. ¼ cauliflower, chopped** Drain liquid through a strainer or cheese cloth. ¼ kale, chopped** Cool liquid in refrigerator overnight. 4 garlic cloves, minced Storage options: 1 tsp thyme 1. Store in refrigerator and use within a few days. 1 tsp parsley 2. Freeze in cup size containers. 1 bay leaf 3. Freeze in Ziploc bags. Pepper and any other additional seasonings to taste 4. Pour stock into ice cube trays. **can dominate flavor TIP This can be used as a base for vegetable soup or as a cooking liquid for other

recipes to add flavor while avoiding the addition of fats.

Staff Recipe

Pickled Mushrooms INGREDIENTS DIRECTIONS 1 pound small fresh white mushrooms Wash mushrooms well. Trim and set aside. 1 garlic clove, minced Combine all remaining ingredients in a large saucepan. Bring to a boil. 1 tsp onion powder Add mushrooms. Boil for 8 – 10 min or until mushrooms are just tender. ½ cup fresh parsley, chopped Chill mushrooms in liquid for at least 2 hours. Drain before serving. 1 bay leaf ½ tsp dried thyme 2 cups white vinegar 3 tbsp lemon juice SERVING: 4 ‐ 6

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Recipe reference: lpl.arizona.edu

Recipe reference: squidoo.com

Stuffed Mushrooms INGREDIENTS DIRECTIONS 4 large Portobello mushroom caps Wash mushrooms carefully and cut off stems. Dice and set aside. 1 cup white vinegar Stir together white vinegar, garlic powder and onion powder until blended. ½ tsp garlic powder Place mushroom caps into a large re‐sealable plastic bag. ½ tsp onion powder Pour in vinegar mixture, seal bag and turn gently to coat mushrooms evenly. 2 cups fresh spinach, chopped Place in refrigerator for 1 hour.

Pepper and other seasonings to taste Pre‐heat oven to 400˚F. Remove mushrooms for marinade. Shake off excess and discard marinade. Place mushrooms on baking sheet. Bake for about 15 min until liquid runs out and mushrooms are browned and have shrunken to about half their original size. In a frying pan over medium heat, sauté the diced mushroom stems with the spinach and seasoning. Add the liquid from the mushroom pan to your skillet until the spinach is soft/wilted. SERVING: 4

Staff Recipe

Cucumber & Dill SaladINGREDIENTS DIRECTIONS 1 seedless European cucumber or 2 American cucumbers Wash the cucumbers and partially remove the peel in lengthwise 3 tbsp white vinegar strips using a vegetable peeler and leaving a little skin between 1 tbsp sucralose (Splenda®) each strip. Fresh ground black pepper Thinly slice the cucumber widthwise. 1 small red onion, sliced and broken into rings Place the vinegar, sucralose and pepper in a bowl and whisk until 3 tbsp fresh dill, chopped the sucralose is dissolved. Add the cucumber, onion and dill. Toss well. SERVING: 4 TIP

The salad can be served immediately, but it will improve the flavor if you let the ingredients marinate for approximately 5 min.

Kale INGREDIENTS DIRECTIONS 2 bunches kale Rinse kale well and place in a large bowl of cold water. ½ cup water Drain and cut off the tough stems. Cut leaves into ¼ inch strips. ¼ cup vinegar In a wok or large frying pan, heat water and vinegar over moderate to high heat. Add 4 cloves garlic, finely chopped the garlic and cook. Stir every 30 seconds. ½ tsp fresh ground black pepper Add the greens and cook. Stir until they begin to wilt and turn bright green. 1 tbsp lemon juice Stir constantly for approximately 8 minutes. Crushed red pepper to taste (optional) Season with pepper, lemon juice and crushed red pepper. SERVING: 8

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Recipe reference: allrecipes.comThirst Quencher Ginger Lemonade INGREDIENTS DIRECTIONS 1.5 cups sucralose (Splenda®) In a saucepan, combine sucralose, water & ginger. 2 L water Heat to a boil and stir occasionally. 7 slices ginger root Remove from heat and stir in lemon juice. 1 tsp ground ginger Cool for 15 minutes then refrigerate for approximately 1 hour or until chilled. 2 cups fresh lemon juice Serve over ice and garnish with lemon slices. 2 lemons, sliced TIPS If you pour some of the ginger lemonade into an ice cube tray and freeze it, you can keep your beverages chilled without diluting the flavor! SERVING: 10

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Dressings | Vegetable Dips | Marinades – PRE OP

Spicy Mustard Mayhem

Eureka Paprika

Citrus Surprise

Mediterranean Madness

INGREDIENTS DIRECTIONS ¼ cup brown mustard seeds Combine all ingredients into a blender/food processor on high speed until liquefied. ¼ cup yellow mustard seeds Do not fret if your device cannot crush the seeds and/or blend the garlic. Pour into 1 cup white vinegar a storage container and refrigerate until thickened slightly. The longer it sits, the more 1 tsp sucralose (Splenda®) flavor comes out! Stir or shake before using. 1 tsp red pepper flakes 1 – 2 cloves garlic TIPS

#1 Remove the red pepper flakes to create a less spicy version. #2 Use a mortar & pestle to crush the mustard seeds to create more of a paste. #3 If you consider yourself a “texture person” and the solid mustard seeds turns you off, try consuming this dressing/dip with solid, crunchy veggies such as broccoli and cauliflower to mask the crunchiness of the mustard seeds.

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup lemon juice liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tsp sucralose (Splenda®) container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp dried onion powder Stir or shake before using. 1 tsp pepper 1 tsp paprika 1 – 2 cloves garlic

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup water liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tbsp lemon juice container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp dried onion powder Stir or shake before using! 1 tsp pepper 1 tsp oregano 1 tsp basil 1 – 2 cloves garlic

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup lemon liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tbsp orange grind container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp sucralose (Splenda®) Stir or shake before using! 1 – 2 cloves garlic

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Allspice Cinnamon; cassia; dash of nutmeg or mace; dash of cloves

Aniseed Fennel seed or a few drops of anise extract

Cardamom Ginger

Chili Powder Dash bottled hot pepper sauce plus a combination of oregano & cumin

Cinnamon Nutmeg or allspice (use only ¼ of the amount)

Cloves Allspice; cinnamon; nutmeg

Cumin Chili powder

Ginger Allspice; cinnamon; mace; nutmeg

Mace Allspice; cinnamon; ginger; nutmeg

Nutmeg Cinnamon; ginger; mace

Saffron Dash turmeric (for color)

Basil Oregano or thyme

Chervil Tarragon or parsley

Cilantro Parsley

Italian Seasoning Blend of any these: basil, oregano, rosemary and ground red pepper

Marjoram Basil; thyme; savory

Mint Basil; marjoram; rosemary

Oregano Thyme or basil

Parsley Chervil or oregano

Red Pepper Dash bottled hot pepper sauce or black pepper

Rosemary Thyme; tarragon; savory

Sage Poultry seasoning; savory; marjoram; rosemary

Savory Thyme; marjoram; sage

Tarragon Chervil; dash fennel seed; dash aniseed

Thyme Basil; marjoram; oregano; savory

Spice & Herb Substitution Chart

Spice Substitutions

Herb Substitutions

Reference: http://homecooking.about.com/library/weekly/blherbsub.htm

Food Guide 39

Favorite Flavor Combinations

Pesto Gingery Garlic Spicy Garlic

¼ cup basil, chopped 1 clove garlic, chopped Pinch ground black pepper

1 tsp ginger, grated 1 clove garlic, chopped ¼ tsp lime zest (grated lime peel)

1 tsp red pepper flakes 1 tsp ginger, grated 1 clove garlic, chopped

Garlic n Herb Tikka Masala Spiced Curry

Chili & Lime

2 tbsp fresh parsley, thyme, rosemary, chopped 1 clove garlic, chopped

2 tbsp cilantro, chopped 1 tsp lemon juice ½ tsp garam masala ¼ tsp smoked paprika 1 clove garlic, chopped

2 tbsp cilantro, chopped 1 tsp curry powder 1 tsp lime juice ¼ tsp lime peel, grated Pinch ground cayenne

¼ tsp lime zest 1 tbsp lime juice 2 tbsp chili powder

Reference: http://www.becel.ca/en/becel/HeartHealthyRecipes/Condiments‐and‐Spreads/Corn‐on‐the‐cob‐topping‐twisters.aspx

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APPENDIX2|Post‐OpRegimenRecipes

The full fluid stage is one exciting step closer to getting back to normal consistencies and intakeroutines. However, it still demands attention to texture and nutrient density. Below are a fewsmoothierecipesthatdonotincludetheSmartShapeShaketohelpchangeupthetasteprofileyouare experiencing. These recipes are meant to increase the quality of your overall nutrition withspecialattentiontoproteinlevelsforthepurposeofstavingoffhungerpangsandassistingthebodythroughthehealingprocess.Pleasenote that thevolumeproducedbyeachof the recipes isnotmeant tobe consumed inonesitting,sofeelfreetostoreitinthefridgeandsiponitthroughoutthedayoreventhenextdayatyourleisure.Remembertoavoidtheuseofastraw,sipslowlyfromaglass,andpaceyourselfwhilebeingmindfulofanyintoleranceordiscomfortthatyoumayormaynotexperience.

Food Guide 41

*It is incredibly important that flaxseeds are ground to a very fine texture similar to that of sand. You may purchase already

ground flaxseeds at your local supermarket, or you can choose to grind whole flaxseeds yourself. If you select the latter option,

pour the flaxseeds into a coffee grinder and adjust the setting to the finest grind. Allow the grinder to run for about 20

seconds. To increase the shelf life, store them in an airtight opaque container in the fridge.

Scrumptious SmartShape™ Shake Recipes | POST‐OP

Tropical Temptation INGREDIENTS DIRECTIONS ½ cup (125mL) of skim milk, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1/3 cup (100g) of vanilla yogurt, 0% fat Strain and enjoy! 1 cup (165g) fresh mango chunks ½ cup (82.5g) fresh pineapple chunks ½ banana (62g), mashed ½ cup (125mL) cranberry juice 1 tsp (5 mL) honey ½ cup (125g) ice NUTRITION QUICK FACTS: Calories ‐ 356 kcal | Protein ‐ 10.99 grams | Fibre ‐ 5.3 grams

Lean & Green INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla Greek yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 cup (67g) fresh spinach Strain and enjoy! 2 cups (340g) honeydew melon, peeled, deseeded, chopped 1 small (148g) fresh pear, peeled, chopped 1 tbsp (30mL) frozen orange juice 2 tsp (10mL) honey 1 tbsp (14g) extra‐fine ground flax seeds* ½ cup (125g) ice NUTRITION QUICK FACTS: Calories ‐ 408 kcal | Protein – 14.88 grams | Fibre – 9.9 grams

Tangy Delight INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla Greek yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 cup (189g) canned oranges, strained Strain and enjoy! 1/3 cup (82g) pineapple 2 tbsp (60mL) frozen orange juice ¼ tsp (1.25mL) vanilla extract 2 tbsp (14g) extra‐fine ground flax seeds* ½ cup (125g) ice NUTRITION QUICK FACTS: Calories – 388.2 kcal | Protein – 14.8 grams | Fibre – 7 grams

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TIPS & TRICKS

FLAVOR – If you find the flavor of any of the smoothies to be overwhelming, you can always add more water

or ice, to increase the dilution factor.

PROTEIN – To increase the protein content in your smoothies, you can substitute Greek yogurt, or select a

high a protein powder additive. See NUTRITION section of this guide for more information.

BLENDING – Sometimes you may find that not all the ingredients have been blended thoroughly, so it is

mentioned that each smoothie must be strained before consumption. To prevent waste, ensure to blend for

at least 25 seconds and consider re‐blending the items left behind in your strainer.

FREEZING – Sometimes storing your excess smoothie in the fridge can cause separation and taste changes

over time. A good alternative is it to freeze them instead. A great way to preserve your smoothie’s flavor

and texture is to turn it into popsicles! Simply pour the smoothie into popsicle molds and freeze for about 5

hours. You can also freeze them in ice trays and thaw out however, many cubes as you would like.

SMOOTHIES THAT SIT – It isn’t uncommon to have separation of ingredients when smoothies are left sitting

in the fridge. If you encounter this challenge, make sure to shake your smoothie vigorously before

consumption. Also, consider pouring half your smoothie into an ice cube tray so that future shakes can avoid

dilution but are still kept cold!

INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 medium peach (150g) , peeled, cored and Strain and enjoy! cut into halves 1 cup (152g) fresh strawberries, sliced 1/3 cup (41g) raspberries, fresh or frozen 1 tbsp (14g) extra‐fine ground flax seeds* 1 ½ tsp (7.5mL) honey 1.2 cup (125g) ice NUTRITION QUICK FACTS: Calories ‐ 292 kcal | Protein – 8.58 grams | Fibre – 8.8 grams

Dairy‐Free Berry Blast INGREDIENTS DIRECTIONS 1/3 cup (41g) raspberries, fresh or frozen Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1/3 cup (49g) blueberries, fresh or frozen Strain and enjoy! 1/3 cup (48g) blackberries, fresh or frozen ½ cup (77g) cherries, without pits ½ banana(62g), mashed 1 tbsp (30mL) frozen orange juice ½ cup (125mL) fortified vanilla soymilk 1 tsp (5mL) honey ½ cup (125mL) decaf earl grey tea, steep 1 bag NUTRITION QUICK FACTS: Calories ‐ 304 kcal | Protein – 6.32 grams | Fibre – 9.7 grams

Peachberry Pleasure

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INGREDIENTS DIRECTIONS 1 12oz. box of firm silken tofu Add all ingredients in a blender and blend until smooth. Place in refrigerator until ¼ cup cocoa powder thickened. Keep covered in fridge until ready to eat. 2‐3 tbsp (or to taste) sweetener of choice 1 tbsp milk (1% or almond/soy/ rice milk) 1 tsp vanilla extract ½ ground instant coffee ½ tsp salt

Chocolate Protein Pudding

Spiced Squash INGREDIENTS DIRECTIONS 1 butternut squash Preheat oven to 400F. Roast butternut squash until soft for approximately 45 minutes. ½ tsp vanilla extract Add all ingredients to blender and blend until smooth. 1 tsp maple extract 1 tsp cinnamon ¼ tsp nutmeg ¼ tsp ginger ¼ tsp salt

Roasted Mushroom & White BeansINGREDIENTS DIRECTIONS 1 can white kidney beans (Cannellini) Preheat oven to 350F. Roast mushrooms in oven until soft and dark (15 mins). Sautee 8oz. Cremini mushrooms onions and garlic until tender and translucent. Add all ingredients into a blender and 1 tsp minced garlic blend until smooth. 1/3 cup chopped onion 1 tsp black pepper 1 tbsp lemon juice 1 tsp finely chopped fresh thyme 1 tbsp olive oil

DDeelliicciioouuss PPuurreeee RReecciippeess || PPOOSSTT‐‐OOPP

INGREDIENTS DIRECTIONS 3‐4 potatoes or sweet potatoes, peeled/mashed Add white beans, onion, garlic & broth to blender or food processor. ½ can white beans, drained/rinsed Puree until thin (no clumps). Mix into mash potatoes. ¼ cup broth (vegetable, chicken or beef) Add skim or 1% milk, if needed. ½ small onion, chopped ½ tsp garlic powder (or 1 tsp minced garlic)

High Protein Mashed Potatoes

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Reference: Ottawa Hospital and University Health Network (UHN)

Savoury Beef Puree INGREDIENTS DIRECTIONS ½ pound (225g) boneless lean beef (cut into 1 inch cubes) Place meat & water in a saucepan. Bring to a boil. 1 cup water or broth Reduce heat & simmer for 30 min. or until meat is tender. Salt & pepper to taste Remove from heat and let cool. Refrigerate until chlled. Blend or puree meat with broth until smooth. TIPS Season with salt & pepper. To improve the color, add a tbsp. of tomato sauce or Pour into containers. Cover, label & freeze. a tsp of tomato paste while blending.

Perfect Poultry Puree INGREDIENTS DIRECTIONS 1 pound (500g) chicken or turkey pieces (bone in, skin on) Place chicken or turkey pieces in a saucepan with water. 2 cups water or broth Bring to a boil then reduce heat. Simmer for 45 min. or until meat ½ tsp thyme or sage separates easily from the bone. Salt & pepper to taste Remove from heat. Let cool. Reserve the cooking liquid. Remove from skin, fat and bones. Cut meat into small pieces. Puree meat with some of the cooking liquid, salt, pepper & thyme. Pour into containers. Cover, label & freeze.

Power Packed Legume PureeINGREDIENTS DIRECTIONS 1 cup (250mL) dried legumes In a medium saucepan combine legumes & 3 cups of water . 8 cups water or broth Bring to a boil over medium heat. Boil gently for 2 min. or soak overnight. ½ tsp cumin or curry powder Remove from heat and let stand for 1 hour. Skip this step if you are making lentils. Salt & pepper to taste Drain legumes. Add 5 cups of water and bring to a boil. Reduce heat. Simmer for 40 – 60 min. Remove from heat and blend with ¾ cup cooking liquid or vegetable broth. Season with salt, pepper and a pinch of cumin or curry powder. Pour into containers. Cover, label & freeze. TIP Canned legumes are already cooked. Just rinse and puree with a little broth or vegetable juice.

Herb & Cheese Mashed CauliflowerINGREDIENTS DIRECTIONS 1 ½ cups cauliflower florets Steam cauliflower for about 10‐15 min. until very tender. ½ can white beans, drained, rinsed Add cauliflower to remaining ingredients in a food processor or blender. ¼ cup skim or 1% milk Puree until smooth (no clumps). 2 tbsp low‐fat or light herb & garlic cream cheese 1‐2 tbsp finely chopped green onion 1 tbsp parsley (fresh or dried) 2 tsp margarine Salt & pepper to taste

Food Guide - Sleeve Gastrectomy - SmartShape · Avoid snack foods such as potato chips, tortilla...

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