Nutrition and Weight Loss Surgery Donna Logan, RD, LD [email protected] Maddie Orsak, MS, RD, LD...
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Transcript of Nutrition and Weight Loss Surgery Donna Logan, RD, LD [email protected] Maddie Orsak, MS, RD, LD...
Nutrition and Weight Loss Surgery
Donna Logan, RD, [email protected]
Maddie Orsak, MS, RD, [email protected]
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
• 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
• B12
• Sublingual (350-500 mcg/day)
• Nasal spray (500 mcg/week )
• Intramuscular injection (1,000 mcg/month)
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
• B12
• Sublingual (350-500 mcg/day)
• Nasal spray (500 mcg/week )
• Intramuscular injection (1,000 mcg/month)
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
• B12
• Sublingual (350-500 mcg/day)
• Nasal spray (500 mcg/week )
• Intramuscular injection (1,000 mcg/month)
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
• Difference between procedures is how much time is spent on a stage
• Why?• Safety • Avoid leaks• Avoid nausea
and/or vomiting• Promote
healing
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
• 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
Goalhydration 64 oz/day &adequate
protein intake> 60 gms/day
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 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
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
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
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.