1	Nutrition after Bariatric Surgery
2	Procedures Roux-en-Y Gastric Bypass Restriction ~ 1 oz. Malabsorption: Bypass lower 90% of stomach and duodenum Lap-Band Restriction ~ 1 oz. “Pacemaker” for eating
3	Dumping Sugar in foods or fluids Eating too fast Drinking fluids with meals Small intestines adapt during 1st year
4	Medications Pills or caplets should be < 1/4” Crush, chop or use liquid medications Gel or powder filled capsules are acceptable Change dosage or medications only if approved by MD
5	Supplements Multiple vitamin mineral supplement Chewable or capsule with > 100% RDA Bariatric Advantage, Centrum, Flintstone (adult dose) B12 & Iron Supplement Trinsicon, Ferotrinsic, or equivalent Iron 18 mg/day, B12 1000 mcg 2-3x/week Calcium 1200-1500 mg/day Calcium citrate in chewable or liquid
6	Supplement Tips Take iron and calcium several hours apart Use pill dispenser or system for keeping track of supplements If supplement is causing discomfort, call RD
7	Rules of the Game Goal of eating 3 meals and 1-2 snacks per day, no more than 5 hours apart Consume protein first, then vegetable, and finally fruit or starch Chew well and eat slowly Stop drinking fluids ~10 minutes before meals or snacks and resume drinking 30 minutes after meals or snacks
8	Soft Diet (start 2-4 weeks post-op) Add one new food per meal or snack Eat soft diet for 1-2 weeks Suggestions: Hot cereal with milk, blenderized soup, cottage cheese or yogurt, applesauce, melon, cooked vegetables, soft cooked egg, tofu Spicy or salty foods often well tolerated
9	Meals and Snacks Meals 1/2 to 1 cup volume Use small plates, bowls and utensils Snacks Do not graze 150-200 calorie maximum
10	Protein At least 60 grams of protein per day Check protein content in handout, handbook, and on nutrition labels Choose low fat protein sources
11	Vegetables Salads and fresh vegetable tolerated if chewed well Do not add high calorie dressings, sauces or butter Fiber helps with satiety and prevents constipation
12	Fruit Check sugar content in juices and canned fruit Avoid large seeds or pits Fiber beneficial for satiety and constipation prevention
13	Starches Should be last item consumed at meals Bread, tortillas, white rice may cause discomfort Avoid adding high fat sauces, butter or margarine
14	Fluids Goal of 64 oz. fluid per day (2 quarts or 2 liters, 8 8-oz cups) Low calorie beverages such as Crystal Lite, Propel, sugar free Kool Aid and water Avoid carbonated
15	Chewing Chew ~20 times per bite, count at first Focus on eating, not conversation or TV Mixing food with saliva assists with digestion and passage through gastric outlet into intestines
16	Exercise Get at least 30-40 minutes of activity a minimum of 3-4 times per week Add strength training 6-8 weeks post-operatively Exercise preserves muscle mass & increases metabolism
17	Eating Out Use card for small servings Split a meal Bring take home containers/bags Ask to have food prepared in low fat manner
18	Nutrition Websites eatright.org USDA.gov fitday.com obesityhelp.com