Highland Hospital Bariatric Surgery CenterPU R EED M EAL PL AN (4 weeks)The Pureed Meal Plan is designed for your health, safety, prevention of complicationsand to prevent unpleasant physical symptoms such as pain, nausea, vomiting, diarrhea.IF A FOOD OR BEVERAGE IS NOT ON THIS LISTDO NOT EAT ITHigh Protein Supplement Needs To Be Continued For 4 Weeks Always Eat From The Protein List FirstImportant Tips to RememberStop Eating When Satisfied Aim for AT LEAST 60-75 GRAMS of protein per day:See sample menu. Continue consuming (2) 8 ounce serving of a high protein supplement. Eat protein foods first. NO BABY FOOD. All foods must be applesauce consistency. Add foods slowly and one at a time to test tolerance. No gum (can cause blockage). Eat slowly, take your time. Stop drinking ½ hour before and wait ½ hour after meals to drink fluids. Sip fluid slowly. TOTAL VOLUME PER MEAL SHOULD EQUAL NO MORE THAN 1/2 CUP. Stopeating or drinking when satisfied, overfilling may stretch the stomach pouch and hinder weight loss.Tips for Preparing Puree FoodsUse a blender or food processor1. When pureeing foods add only enough liquid to obtain applesauce consistency to maximize yournutrient intake in a limited volume.2. Meats need to be tender (stewed, baked or broiled) before they can be pureed. Cook in crock pot untilvery tender. Add low-sodium broth, low-fat gravy or low-fat milk to add moisture to the meats whenblending.3. Use light mayonnaise when blending tuna or egg.4. Add low-fat milk to hot cereal or mashed potatoes to increase protein content.5. Add 1-2 tbsp. of protein powder to foods to increase protein.6. May add Butter Buds or Butter Spray to season foods or spices as tolerated.5.161
Highland Hospital Bariatric Surgery CenterTOTA L VOLU M E PER M EAL S H O U L D E Q UA L N O MO R E T H A N 1 / 2 C U P¼ cup – ½ cup at each mealPROTEIN FOOD ITEMSPROTEINSUPPLEMENTS** 3 MEALS DAILY*** 2 TIMES DAILY* Pureed chicken or turkey (no skin) Pureed fish Soft fish – haddock, tilapia, cod andsalmon, flounder can be mashedwith fork Canned tuna mashed with fork Canned chicken mashed with fork Pureed tofu Scrambled eggs or egg substitute Fat-free refried beans (pureed) Strained, cream soups made with low-fatmilk (98% fat free) 1% cottage cheese Part skim ricotta cheese Sugar-free, homemade puddingw/low-fat milk Milk or lactaid (skim, fat free or 1%) Soy milk light (plain or vanilla) Plain or light, low-fat yogurt orGreek yogurt – no fruit pieces8 ouncehigh protein shakeCONDIMENTS 5.16Low-fat or fat-free mayoMustardFat-free spray butterSpices / HerbsORChoose an itemfrom alternativehigh proteinsupplement.OPTIONAL FOODSAdd only after consuming proteinFRUIT – Pureed, cooked or canned(no added sugar) Pureed peachesApplesauceMashed bananaPureed pearsPureed melonPureed apricotsPureed pineappleVEGETABLES – fresh, frozen, canned,very tender, cookedwithout seeds, hulls, skins Pureed peas Pureed carrots or very tender, cookedcarrots mashed with fork Pureed green beans Pureed beets or very tender, cookedbeets mashed with fork Pureed spinach Pureed tomato sauce Pureed roasted peppers Pureed wax beans Pureed mushroomsSTARCHES Pureed peas Pureed acorn or butternut squash Pureed sweet potato Cream of wheat, oatmeal & grits madewith skim milk or 1% milk Mashed potato2
Highland Hospital Bariatric Surgery CenterSAMPLE MEAL PLANBreakfast1/4 cup scrambled egg and 2 tbsp. fruit OR 1/3 cup cottage cheese with 2 tbsp. fruitSnack8 oz. HIGH PROTEIN SUPPLEMENTLunch1/4 cup – 1/2 cup pureed chickenSnack8 oz. HIGH PROTEIN SUPPLEMENTDinner1/4 cup – 1/3 cup mashed fish with light mayo and 2 tbsp. pureed cooked vegetablesSnack1/2 cup light Greek yogurt OR 8 oz. soy or 1% milkFLUIDS6 – 8 cups of non carbonated sugar-free beverage *THROUGHOUT THE DAY* Water Unsweetened decaf tea Decaffeinated coffee Sugar-free beverages Broth Sugar-free popsicles Sugar-free gelatin5.163
Highland Hospital Bariatric Surgery CenterALTERNATIV E H IG H -PROT EIN SU P P L E ME N T SThis list can be used to replace a protein shake.You will need to purchase protein powder to make these recipes.For best absorption of protein, do notexceed more that 20 grams of proteinin one serving of protein powder.Protein powder must be:15 – 20 grams of protein and5 grams or less of sugar and fat.High-Protein Oatmeal1. ½ cup oatmeal – make oatmeal as directed but make with low-fat milk instead of water.2. After oatmeal is cooked stir in 1 scoop of protein powder (can be plain or flavored), until well blended.3. Optional: add 2 oz. of additional milk, add cinnamon or nutmeg.High-Protein Cottage Cheese1. Add a little cold water to a scoop of protein powder (can be plain or flavored), stir to make a paste.2. Add protein paste to ½ cup low fat cottage or ricotta cheese.3. Stir until blended well.High-Protein Decaf Coffee1. Add a little cold water to a scoop of protein powder (can be plain or flavored), stir to make a paste.2. Add paste to bottom of mug, pour 8 oz. of decaf coffee, and stir well.3. Optional: any non-fat creamer, sugar-free syrup, cinnamon or nutmegHigh-Protein Hot Chocolate1. Add a little cold water to a scoop of protein powder (can be plain or flavored), stir to make a paste.2. Add paste and 1 packet of SUGAR-FREE hot cocoa mixture to bottom of mug.3. Heat 8 oz. of low-fat milk, pour hot milk into mug and stir well.4. Optional: add cinnamon, nutmeg, any flavor sugar-free syrup or 1 tbsp. light Cool Whip.High-Protein Chai Tea1. Add a little cold water to a scoop of protein powder, stir to make a paste.2. Add paste and 1 packet of SUGAR-FREE CHAI MIXTURE to bottom of mug.3. Heat 8 oz. of low-fat milk, pour hot milk into mug and stir well.High-Protein Cream Soup126.96.36.199.5.16Add I can of 98% fat-free cream condensed soup and 8 oz. of low-fat milk, bring to a simmer.Add 2 scoops of plain protein powder and stir well.Take off heat and carefully strain any chunks of food.Pour 1 cup of soup in bowl (makes 2 servings).4
GP1HELPFUL HINTS - 1ST MONTH AFTER SURGERYCALL THIS OFFICE IF YOU ARE EXPERIENCING ANY OF THE FOLLOWING: Increasing abdominal pain.Diarrhea, more than six episodes a day.Your surgical incisions become increasingly red into the skin surrounding the incisionor have foul drainage.Nausea and vomiting and are unable to consume the recommended food and fluid.A fever greater than 101.5IF YOU ARE EXPERIENCING A LIFE THREATENING CONDITION, CALL 911 OR GO DIRECTLY TO THEEMERGENCY ROOM.IF YOU HAVE QUESTIONS OR CONCERNS THAT ARE NOT LIFE THREATENING, PLEASE CALL THEOFFICE BEFORE GOING TO THE EMERGENCY ROOM (585-341-0366).BARIATRIC MEDICATIONS / VITAMINSGastric BypassSleeve GastrectomyCompleteMultivitamin/MineralORCelebrate One/60 chews orTABSCalcium citrate 600mg/ VitD400 IU(Total of 1200-1500 mgcalcium daily)Omeprazole Reduces acid in yourstomachUrsodiol – helps you toavoid gallstone formationIronFerrous sulfate325 mg daily(Total of 65 mg elementaliron daily)Vitamin B121000 mcg daily2x daily for the rest ofyour lifeORCelebrate 60, twice a dayfor the rest of your life2x daily for the rest of yourlifeORCelebrate One, once a dayfor the rest of your life2x per day for the rest ofyour life2x per day for the rest ofyour life1x per day for 2 monthsonly (unless you have ahistory of GERD)2x per day for 6 months,only if you have agallbladder1x per day for 2 monthsonly (unless you have ahistory of GERD)2x per day for 6 months,only if you have agallbladder1x dailyIf you are takingCelebrate you do notneed to take additionaliron1x dailyIf you are takingCelebrate, you do NOTneed to take thisThiamin (B1)Minimum of 12 mg dailyCalcium carbonate can beused but should be takenwith meals1x dailyIf you are takingCelebrate, you do NOTneed to take thisYour provider will let youknow if you need to takethis.Separate calcium and ironby 2 to 3 hours for bestabsorption of both minerals1x dailyIf you are taking Celebrate,you do NOT need to takethis1x dailyIf you are taking Celebrate,you doNOT need to take thisMost doses are 50 mg or100 mg
GP1HYDRATION It is important that you drink 64 ounces of fluid each day. Not getting the recommended daily fluidintake can cause nausea, headaches, decreased energy levels and constipation.DIET – Pureed foodAll foods must be applesauce or baby food consistency. Your pouch is in the healing phase.Consuming foods not on the pureed diet will put you at risk for complications.Protein intake is very important. Be sure to set a goal of at least 60g or more of protein per day. If youhave any questions on the meal plan please send the dietitian a MyChart message. If you do not haveMyChart, you can call the Dietitian at 585-341-0366. SKIN CAREIf you have glue on your incisions, this will fall off on its own. Steri-Strip bandages may have been applied.You may shower with them on. Pat them dry after showering. They will eventually dry up and the ends willbegin to curl. This may take up to 5 days. You may take them off when this happens.Do not apply any lotions or antibiotic cream to your incisions.Do not cover your incisions with Band-Aids unless they are draining or rubbing against your clothing.Showers only. NO swimming, baths or hot tubs until your incisions have healed and any scabs havefallen off. DO NOT TAKE NSAIDS Ever (for the rest of your life)!Non-Steroidal Anti-Inflammatory DrugsDo not take NSAID medications. For example ibuprofen, naproxen, Motrin, Advil, Aleve, Celebrex andMobic. These medications will increase your risk of ulcer formation and GI bleeding.EXERCISE Activity as tolerated.You may start walking outside or on a treadmill as soon as you feel well enough. Work your way upgradually to 30 minutes per day of exercise, 5 days per week.CONSTIPATIONConstipation is common after bariatric surgery due to iron supplement, pain medication, decreased fluidintake and decreased fiber intake. What you can do: Increase your fluid intake. Continue with Miralax twice a day and Colace twice as day. If you are not moving your bowels at your normal pre-surgery frequency, you can increase the Miralax tothree times a day for one day. If you do not have results after this, you may use one of the following.Please follow package instructions:o Milk of magnesiao Magnesium citrateo Dulcolax pills or suppositoryo Fleets enema
GP1SMOKINGNO SMOKING! Smoking increases your risk of gastritis or ulcers in your pouch.BIRTH CONTROLWeight loss can increase fertility. You must wait at least 1 month after surgery to use birth control pills.In the interim, all females of childbearing years who are sexually active must either refrain or use a condom asa form of Birth Control. We strongly recommend that you DO NOT BECOME PREGNANT until 2 years afteryour surgery. It has been shown that women who had absent or irregular periods before surgery are likely tobegin regular cycles and ovulation with weight loss. If you were not able to get pregnant before surgery thiscan change with weight loss.MONARCH SUPPORT GROUPThe Monarch meetings are held on the 2nd Wednesday of each month from 6:00pm-7:00pm via Zoom. You canregister for these meetings through our event page located on our website. A great opportunity to share andlearn from others. RETURN TO WORKIf your procedure was done laparoscopically you will return to work 2 weeks after your day of surgery,sooner if you are feeling up to it. You will not have any restrictions once you return to work.There is no exception to this policy unless you have experienced complications in the postoperative period.YOUR WEIGHT LOSSDo not weigh yourself more than 1x per week for the first 3 months. Fluid intake and constipation can affectweight. This can be discouraging to you.Make sure you are eating and drinking as recommended in this packet. You will be weighed at each of youroffice visits.Our goal is for you to lose 60% or more of your excess body weight at the end of your first year. The rate ofweight loss differs between people. Try not to compare yourself with anyone else.OFFICE VISIT SCHEDULEResearch shows that patients who consistently follow up with visits to their surgeon’s office maintaina higher percentage of weight loss.7-10 days post op4-6 weeks post op2-3 months post opToday’s visitThis visit will be with the dietitian and will be held via Zoom. Nolabs will be drawn at this visit. Please keep a food journal forone week prior to your visit so that you may review this withthe dietitian.Labs will be drawn at this visit and at every visit from now on.6 months post op.Labs will be drawn.1 year post op.Labs will be drawn. You should return to this office every year.
GP1YOUR LAB RESULTS and MyChartLab Results: You will receive a MyChart message or a letter from this office if your labs are abnormal andrequire any adjustment to your vitamins/supplements. If your labs are all within normal limits you will notreceive a message or a letter.How to access your lab results: You may access your labs through MyChart at mychart.urmc.edu. If youdo not have a MyChart account, click on the button “Request activation code” on the left side of the screenunder “New User?”We will check the following labs at each visit: 12/2020CBCChemistryVitamin DIronPTH FerritinB12Folate
Highland Hospital Bariatric Surgery Center 3 SAMPLE MEAL PLAN Breakfast 1/4 cup scrambled egg and 2 tbsp. fruit OR 1/3 cup cottage cheese with 2 tbsp. fruit Snack 8 oz. HIGH PROTEIN SUPPLEMENT Lunch 1/4 cup - 1/2 cup pureed chicken Snack 8 oz. HIGH PROTEIN SUPPLEMENT Dinner 1/4 cup - 1/3 cup mashed fish with light mayo and 2 tbsp. pureed .