Nutritional management of the pre and post bariatric patient

Amy Ayres, RD, LDN

Bariatric Surgery Types-RNYGB

Bariatric Surgery Types-Gastric Sleeve

MSD’s• Goal is to follow a diet and decrease weight before surgery• Lifestyle change• No chugging fluids• Chew foods thoroughly• Minimum 60 grms. Protein/day• Low carbohydrate• No Skipping meals • 64 oz. sugar free non carbonated fluids/ day• No eating and drinking together

Pre- op Diet 1 – 2 weeks prior to surgery • Goal is to shrink liver• Protein shakes as meals

Preparing

Daily Vitamins

Multivitamin

• Complete formula

• Thiamin: 50 mg/day

• Folic Acid:400-1000 mcg/day

• Vit D: 3,000 IU/ day

• Vitamin A, E, K Cu, ZN

Calcium (1200-1500 mg daily)

• 500-600 mg, 2-3 times daily.

• Calcium Citrate* vs. Calcium Carbonate

• Vitamin D for better absorption

Vitamin B12 (500 mcg)

• Monthly Injection or

• Sublingual pill

Iron

• At least 45- 60 mg/day

• Take with Vitamin C

• DON’T take with calcium

Use a liquid or chewable form, and take FOREVER

Dumping syndrome• Limit sugar to 10 grams

a meal

• Happens 15-30 minutes after a meal.

• Rapid emptying of your stomach due to undigested food

• Symptoms include• Bloating

• Nausea

• Cramping

• Diarrhea

Diet Following Surgery

Full Liquid Diet

Sugar free hot chocolate

Sugar free, low fat pudding

Skim milk Vegetable juiceLow fat strained

creamy soups

Protein shakes: Whey protein isolate

powder, pre-made

Clear Liquid Diet(4 oz./ hour)

Water Unsweet Tea

Low fat/Fat free

Broth/Bone broth

Coffee, no cream

Sugar free lemonade

Propel water, fruit 2-O

(carbonation free water)

Sugar free gelatin (no

red)

Sugar free popsicles (no

red)

Crystal light varieties (no

red)

Puree Diet Protein first, vegetables, fruit,

starch last

No pieces or chunks

Keep a food journal

Maintain 4-6 weeks

Measure our foods

Low in sugar

Plan for your meals

• Blended fruit (no seeds/skin)

• Blended veggies (no seeds/skins)

• Stage 1 baby food

• Protein (chicken, turkey, fish, tofu)

• Do not depend on protein shakes

• All food can be blended w/ skim milk or fat free broth

Food choices include:

Transition Nutrition Therapy• Up to 3 months to

return to a regular consistency diet

• Add one new food at a time

• Continue your food diary

• Take your time

• No eating and drinking together!

• Remember: Protein first, vegetables, fruit, starch last

• For the first 6 months avoid:• Red meat and pork

• Raw veggies including skin and seeds

• Raw fruit including skins and seeds

• Pasta, bread, and rice

Protein choices• Meat

• Cooked meat

• Fat free hot dog

• Low fat lunch meat

• Legumes

• Nuts

• Peanut butter

• Refried beans

• Beans (pinto, black, lentils, limas)

• Chili beans

• Bean soup

• Dairy

– Skim milk

– Yogurt

– Cottage cheese

– Cheese

– Egg/egg substitute

• Soy– Soy milk

– Tofu

– Veggie burger

– Textured vegetable protein

Foods that can cause distress

Beverages

Alcohol High sugar beverages

Soups

Made w/heavy cream

Fruits

Fruit juices Fruit canned in heavy syrup Dried fruits

Starch

Breads (w/dried fruit, nuts, and seed)

Pastries donuts Sugar coated cereal Undercooked rice or pasta

Protein

Fried and high fat meat Fried eggs Tough meat and meat w/skin

6 Months to 1 Year

Slowly add red meat, including

beef, pork, and lamb

Can add whole grains l

Weight should

stabilize in….

RNYGB

14-16 months

Gastric Sleeve

20-24 months\

Review (guidelines for life)

• No straws (forever!)• No sodas (forever!)• Take your daily supplements (forever!)• Keep a food diary• 6-8 small meals/snacks per day• 150-300 minutes exercise week• Food should be low fat, sugar free• Protein first, then veggies, fruit, and starch• Sugar should be less than 5g a meal• No eating and drinking together

Support Groups

• Patients who attended support groups achieved a body mass index (BMI) 1.6 points less than patients who did not attend support groups

• Regular attendance at multi-phasic support group meetings improves post-op recovery based upon specific indicators.

Any ‘s