Food Guide
Nutrition . . . .. . . 4
Effective Strategies to Healthy Eating . . . .. . . 9
I. Reading Food Labels 9 II. Visualizing Your Portion 10 III. Planning Your Meals 10 IV. Weighing Yourself 11 Lifestyle Diary: Rules and Hints . . . . 12
Pre-Operative Guidelines . . . .. . . 14
Pre-Op Regime Side Effects . . . .. . . 19
Post-Operative Guidelines . . . .. . . 20
I. Stage | Clear Fluids 22 II. Stage | Full Fluids 23 III. Stage | Puree Foods 25 IV. Stage | Soft Foods 28 V. Stage | Solid Foods 30 Potential Nutrition Complications After MGB Surgery . . . 31
Appendix 1 | Supplement Regime Schedule . . . .. . . 32
Appendix 2 | Pre-Op Regimen Recipes . . . .. . . 33
SmartShape
™
Food Guide
The Mini Gastric Bypass (MGB) Program is your first step to establishing a healthier lifestyle. It is meant to lengthen your satiety time, decrease your appetite, and help you manage the volume of food you eat. These changes should help you make lifestyle changes that will ultimately allow you to lose weight and sustain weight loss leading to improved health and well-being.
In order to achieve your desired outcomes, you need to be a very active participant, including commitment to an altered relationship with food and eating, as well as modifications to your behavior and activity levels.
The SmartShape™ Food Guide is meant to assist you, through this journey, by detailing basic information that will help you succeed. The guide covers instructions to follow before and after your procedure, as well as general healthy eating recommendations such as how to read nutrition labels, track your lifestyle, adjust the amount and types of food you eat, how you eat them and much more! Please do not hesitate to contact the SmartShape team, our nurses, or dietitians if you have any questions or concerns. We are committed to helping you achieve your weight loss goals in a safe and nutritionally sound manner.
Best Wishes,
Nutrition
We want you to become familiar with basic nutritional information as you start your journey towards adapting new eating habits and making wise healthy food choices.
Nutrients are required by our body every day. There are 6 main groups of nutrients:
1. PROTEIN – Protein is an important part of the structure of all body cells. It is used to build skin, hair and muscle in your body. Your body needs a certain amount of protein each day to stay healthy.
You will see proteins mentioned several times throughout the Food Guide because we really want to stress the importance of this nutrient in each and every meal and snack. You should aim for at least 60-80 grams of protein each day.
Measuring Hints
1 oz. of meat is = to about three to four tablespoons of chopped/ground meat. 1 oz. of grated or cottage cheese, tuna or egg salad is = to four tablespoons.
3 oz. portion size of poultry or meat is = the size of a deck of cards. How Many Grams of Protein in Solid Foods
1 oz. of meat = 7 grams of protein 1 egg white = 7 grams of protein ¼ cup egg substitute =7 grams of protein ¼ cup non-fat cottage cheese = 7 grams of protein ¼ tuna fish in water = 7 grams of protein 1 oz. low-fat or fat free cheese = 7 grams of protein 6 oz. low-fat light yogurt = 8 grams of protein
High Protein Ideas Chicken or Turkey
Pureed chicken/turkey - try mixing it with strained low-fat cream soup Baked, grilled or poached chicken/turkey breasts
Thin sliced or shaved deli slices
Fish
Baked, broiled, poached or grilled fish Shrimp, imitation or real crab Fresh or canned salmon in water Canned tuna in water and other canned fish
Sushi
Beef or Veal (Extra Lean)
Meatballs, meatloaf and potted beef in lean ground beef/veal Pork
Shaved deli ham or deviled ham Eggs or Egg Substitute Scrambled eggs or omelet
Homemade eggnog made with skim milk Diet custard
Egg salad Quiche or frittata
Deviled eggs Low-Fat Dairy Products
Milk (skim or 1%) Yogurt (plain or low fat)
Low-fat cheeses including cottage or ricotta Legumes
Hummus Smooth peanut butter
Dried beans or lentils in soups, stews or chili Vegetarian or fat-free refried beans
Tofu
Additional Ideas for Adding Protein to Foods
Consider adding the following items to low fat milk, yogurt, cottage cheese, hot cereal, de-caffeinated coffee/tea, low fat cream soups, mashed potatoes, casseroles, applesauce or eggs.
Non-Fat/Skim Milk Powder 1/3 cup powder = 8 grams of protein
Egg White Powder 2 tbsp = 6 grams of protein
2. CARBOHYDRATES– Carbohydrates are essential for mental and physical functioning. They are found in foods that contain starch, sugars and fiber such as fruit, milk and alternatives and grain products. Starch and sugar break down into glucose (the sugar in your blood). Glucose is what your body uses for energy. Too much carbohydrate can make it challenging to manage health and weight, especially for those living with diabetes or glucose intolerance.
Choose high fibre carbohydrates most often as they provide the most satiety as well as nutrition. Some examples include: fruit; whole grains like rolled oats, steel cut oats; brown or wild rice, barley, quinoa; roasted potatoes with the skin on or sweet potatoes.
Foods high in sugar and starch should be avoided due to their typically high caloric content. Consuming high calorie foods can result in a loss of control over blood sugar, slower weight loss and even weight gain. You should avoid soft foods as they do not contribute to satiety. Soft, high calorie foods include cookies, cake, chocolate, ice cream, doughnuts, brownies, pastries, frozen yogurt, sweetened cereals, fruit canned in syrup and regular jams, jellies & preserves. High calorie liquids include milkshakes, fruit juice, soft drinks and alcoholic beverages.
3. FAT– Fat is used to cushion body organs and protect nerve cells. However, most people eat much more fat, than what is actually needed. If you are not getting enough carbohydrates, fat can be changed into glucose for your body to use for energy. Conversely, if you consume too many carbohydrates, your body can convert the excess into fat.
Avoid eating close to the bone (i.e. ribs, thighs) or fat pads around the bone Avoid fried foods - remove all visible fat and skin from meats and poultry Avoid “fast food” as these are usually high in fat
Choose lean/low fat products
Avoid high fat dairy products such as whole milk, full fat cream, cheese or cream sauce Avoid high fat pastries, donuts and desserts
Avoid high fat meats such as bacon, sausage and hot dogs
Limit added fats such as butter, margarine, lard, mayonnaise or spreads and salad dressing. Try the low fat alternatives
Avoid snack foods such as potato chips, tortilla chips, cheese curls
You need a small amount of “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter or avocado). However, even healthy fats are high in calories, so they need to be limited to no more than 2 – 3 tbsp per day.
Some pre-packaged or prepared foods can be very high in fat. These foods will be much higher in calories when compared to low-fat foods in the same food group. Unless you read the labels, you may not know which foods are high in fat. We recommend you choose products with less than 15% Daily Value of fat per serving. The following chart lists each category with low-fat, medium-fat and high-medium-fat foods.
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 cheese, tuna fish packed in water, baked fish, egg whites, egg substitute, shellfish, fat-free cottage cheese, wild game
Regular ground beef, low-fat hot dogs, turkey bacon, turkey sausage, 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 though vitamins cannot be changed into energy, they are used by your body to change other nutrients into energy. The vitamins are A, Thiamin (B1), Riboflavin (B2), Niacin (B3), B6, B12, C, D, E, K, Folate, Panthothenic Acid and Biotin.
5. MINERALS– Like vitamins, minerals do not provide energy for your body, but they do play an important part in your body’s chemical processes. The main difference between minerals and vitamins is that minerals are smaller and less complex than vitamins. Some of the minerals that your body needs are Calcium, Phosphorous, Potassium, Sulfur, Sodium, Chloride, Magnesium, Iron, Zinc, Copper, Manganese, Iodine and Selenium.
6. WATER/FLUIDS– Most people need at least eight cups (64oz.) of fluid each day. If you do not get enough, you will likely become dehydrated and can feel weak and tired or even hungry. We recommend sipping on water all day between meals. Consider having 1/3 cup water every 15 minutes. Sucking on ice will also help contribute to fluid intake.
Fluid intake is also important to managing digestive health including diarrhea and constipation. Adequate water is essential to help rid the body of waste, maintain proper muscle tone and elasticity of your skin.
damage. We also recommend limiting your caffeine intake to no more than 320mg/day (approximately three, 250mL cups/day) to avoid dehydrating effects and avoid interactions between caffeine and your calcium levels.
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
Effective Strategies for Healthy Eating
Getting to your optimal health and weight loss goals will require effort and dedication on your part. It is important that you follow the dietary guidelines and optimize how much physical activity you get, to enhance your long term success. We have developed some ideas for you to embrace during your journey to acquire new healthy nutritional habits.
I. READING FOOD LABELS
Knowing how to use information on food packaging can help you make better food choices and thus achieve a healthy regimen. Manufacturers provide information in three ways: nutritional claims, ingredient lists and the nutrition facts table. All of these terms are based on standard serving sizes.
Notice the key words follow the same pattern for each nutrient: Free has the least amount
Very low and Low have a little more
Reduced or Less always mean the food has 25% less of that nutrient than the reference version of the food
Ingredients are listed in order from the most to the least. The earlier you see an unhealthy ingredient listed, the less healthy the food product is for you.
%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. fat.
The HIGHER the better (applies to everything in this section)
Fat
Fats can be saturated, unsaturated (i.e. monosaturated and polysaturated) and trans fats. Trans fats are bad for your heart and should be avoided. We recommend looking in the ingredients section for phrases such as ‘hydrogenated’ or ‘partially hydrogenated’ fat, oil or shortening, to learn if they are present in the food you are buying. Hydrogenated or partially hydrogenated foods likely contain at least some trans fat and should be avoided whenever possible. Saturated fats should be kept to smaller amounts as they can impact cholesterol levels. You can reduce your intake of saturated fats by choosing leaner cuts of meat and lower fat diary, and limiting the use of butter, coconut, and palm oils.
Sugar
To find out whether a sweetener has been added to a food (beyond sugars that are naturally present), look for terms such as sugar (sucrose), fructose, maltose, lactose, honey, syrup, corn syrup, high fructose corn syrup, molasses and fruit juice concentrate. High fructose corn syrup is particularly harmful because it is stored directly as fat in the liver and is harmful to the liver.
II. VISUALIZING YOUR PORTION
Learn to visualize your portions (see box below). Review your choices and food record with the dietitian.
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. PLANNING YOUR MEALS
It is recommended that you choose foods that are high in protein and fiber. Since you will likely be eating smaller amounts of foods, you need to make sure you are getting the best nutrition. In addition, protein and fiber help keep you satisfied for longer.
Low-fat – You should have no more than three servings of fat during your meals each day. One serving usually equals one tablespoon. If you use a low-fat version of these foods, a serving equals one tablespoon. If you use a fat-free version, you do not have to count that as a serving of fat. The foods included in this group are margarine, mayonnaise, salad dressing, canola oil, olive oil, peanut butter, cream cheese, sour cream, shortening and butter.
Liquids – Limit the amount of calorie-containing beverages because they do not contribute to the feeling of satiety and may prevent ideal weight loss. The goal is to choose satisfying foods to prevent you from overeating at meal time, as well as to minimize snacking throughout the day. This will not only help you to lose weight but also help maintain weight loss and health.
Healthier Dining Out Habits – Research has shown that people tend to underestimate the quality and amount of food consumed when eating out. We understand this is an obstacle that patients face every day. Therefore, we recommend practicing portion control at home so you can become comfortable determining serving size when eating out.
If you eat out, we suggest you avoid restaurants that serve deep fried foods with rich sauces. It is much healthier to find a salad bar, sandwich shop or a sit-down restaurant where you can customize your order. We suggest you order meals with protein and fibre compliments.
Another great tip is to look at the online menu of the restaurant in advance to determine any special requests before you get to the restaurant. This is will able you to make wise choices without feeling pressured. We recommend ordering baked, grilled or steamed foods as opposed to fried foods. Try to choose the smallest size regardless of the price difference or try sharing your meal with a friend, or taking home half the meal for consumption the next day.
IV. WEIGHING YOURSELF
We recommend that you weight yourself no more than once a week. Do not let the numbers on a scale determine your mood. Remember they are just guidelines of how you are doing, but not how we define success. Non-scale victories are very important and generally a more satisfying way to measure progress.
You need to learn to identify the feeling of satiety and respect the feeling of not overeating. It is important to be patient along your journey.
Lifestyle Diary | Rules & Hints
From time to time, you may decide or be asked to complete a lifestyle diary. The information you record in your lifestyle diary will help you design an eating pattern to meet your unique needs, bring forth patterns, and assist you in reaching your personal self-management goals. Studies have shown that keeping track of your intakes and behavior for a few days can help you make significant, positive changes in your eating habits.
Write down everything you eat and drink for 3 days. Try to choose 2 days during the week and 1 day on the weekend as our intake patterns tend to change. Do not try to change your eating habits during the 3 days of record keeping. Keep in mind that not all days should be completely “typical” as we want to ensure we analyze and reflect on even our poorest management days.
Helpful Hints
1. WHEN: Indicate the time of day to determine gaps of time between all intakes, beverages included. 2. HOW MUCH: Indicate the amount of the particular food item you ate. Estimate the size (2”x1”x1”), the volume (1/2 cup), the weight (2 oz.) and/or the number of items of that type of food (i.e. 6 pretzels).
3. WHAT KIND: Write down the type of food AND fluid you ate/drank. Be as specific as you can. How was the food cooked? Was it grilled, fried, steamed, or baked? Was it fresh, frozen or canned? If you eat bread, is it white, wheat, whole wheat, rye, honey wheat or multigrain? If you drink milk, it is whole, 2%, 1%, skim, soy, or rice milk? Remember to write down “extras” such as sauces, gravies, salad dressing, mayonnaise, butter, sour cream, sugar and ketchup.
4. ACTIVITY: List any activities you were doing while you were eating. Be sure to include where, such as the cafeteria at work, your desk, a specific room in the house, etc. If you ate at a restaurant, fast-food chain or your car you should record the location as well. Also detail who you were with. If you ate by yourself, write “alone”. If you were with friends or family members, list them.
5. HUNGER and SATIETY SCALE: 1 = not hungry 2 = somewhat hungry 3 = moderately hungry 4 = very hungry 5 = starving
7. COMMENTS: Write down your mood, thoughts, and feelings while you were eating - for example, sad, happy, bored, stressed and depressed. This is a very good and important way to track your “negative” emotions and triggers.
Tips
2. DO IT NOW: Record your eating and drinking as you go. Do not depend on your memory at the end of the day.
3. REQUEST FEEDBACK FROM YOUR CARE TEAM: Be sure to reach out to your care team if you are facing challenges or are interested in feedback; therefore, bring your completed lifestyle diaries with you/email/fax for your next appointment. You can also request a fillable template document to make it easier to complete and send back for analyses and feedback.
Exhibit 1 – Daily Lifestyle Record
INTAKE TIME AMOUNT FOOD / BEVERAGE
DESCRIPTION ACTIVITY DURING INTAKE HUNGER SCALE SATIETY SCALE COMMENTS
Breakfast AM Snack Lunch PM Snack Dinner Evening Snack
Exhibit 2 – Daily Lifestyle Record for Individuals Living with Diabetes
INTAKE 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):
*** Blood sugar goals (subject to change): BEFORE Meals: 4-7 mmol/L AFTER Meals: 5-10 mmol/L or 5-8 mmol/L if A1C targets are not being met.
Exhibit 3 - End of day checklist. Check off the options that describe your intake for the day
I maintained a buffer of at least 45 seconds between my food and beverage swallows I drank eight, 250ml, cups of fluid
Meal volumes were no more than 1 side plate I had protein at every meal
I took my time when eating I did not eat closer than two hours
I did not get my food 'caught' while eating
I did not eat further than 4 hours
Pre-Operative Guidelines
In order to prepare you for your procedure, your surgeon will prescribe SmartShape™ Shake prior to surgery. The amount of time you will be on SmartShape™ Shake will depend on your surgeon’s assessment at the time of your consultation. The purpose of the pre-op regimen is to reduce the fat content and size of the liver through the process of ketosis, not simply to lose weight. By reducing the size of the liver, it makes the surgery more efficient and safer with significantly reduced risks of complications.
1. SmartShape™ Shake is a specially designed, bariatric-specific low carbohydrate, low calorie, high
protein meal replacement. The formula was created to supply individuals with distinct and essential daily requirements of macro and micro-nutrients to prepare the body for surgery. Individuals should aim to consume all three shakes daily.
Helpful Tips
We recommend drinking at least 64 oz. (8 cups) of fluid each day
Avoid sugar, milk or cream in your decaffeinated coffee or tea. You may use calorie free sugar substitutes such as Sweet & Low, Equal or Splenda/Sucralose
Eliminate sugar sweetened carbonated beverages and limit the consumption of sugar-free, carbonated beverages
Eliminate alcohol intake and avoid excessive caffeine intake in an effort to avoid post-op withdrawal symptoms such as headaches
Begin to plan a schedule for your mealtimes and fluid consumption that reflect your own personal schedule
Tweak the Texture & Add Flavor to Your Protein Drink
Sugar free flavor extract or spices can be added (i.e. vanilla or almond extract, cinnamon or nutmeg)
Sugar-free cocoa powder can be added to provide a chocolate flavor
Make a Frappuccino by adding instant decaffeinated coffee with lots of ice to your protein shakes
Sugar-free Crystal Light powder
If your drink is too sweet or thick, try adding more water
Make a ‘hot chocolate’ by warming your chocolate shake up in the microwave/stovetop
3 daily servings SmartShape™ Shakes 250 calories specific low glycemic index vegetables Supplements
Make popsicles, ice chips or a frozen slushy treat by freezing your protein drink For tips, check out Appendix 1 for “Scrumptious SmartShape Shake Recipes”
2. Low Glycemic Index Vegetables. In addition to three servings of shakes per day, you should
include a maximum of 250calories of specific, low glycemic index vegetables per day. There are particular portions specified for each glycemic vegetable that is ‘authorized’ for consumption, so please refer to the following pages for a complete detailed list.
Helpful Tips
Avoid meat, poultry, seafood, dairy products, grain products, fruits, broths, juices including vegetable juice blends, salt, oils and butter
Check out of the “Pre-Op Regimen Recipes” (Appendix 1) in for recipes and ideas on how to flavor your vegetables
3. Supplement Regime.To ensure your body receives complete nutrition in the days leading up to
your procedure and during your post-op stage, it is MANDATORY that you initiate specific
supplements every day for the rest of your life. You should consult with your doctor or pharmacist before starting any supplement to ensure it is safe to do so.
Gummy supplements should be avoided. The quality of gummy supplements is far less than other chewable/liquid forms, therefore it is suggested that individuals avoid gummy supplements throughout their weight loss journey.
Please refer to APPENDIX 1 for the MANDATORY Supplement Regime Schedule. Two options are provided; neither option is better than the other, choose what is best for you! Supplements are mandatory and there is no comparable product sold in local pharmacies. Please order your supplements prior to starting the pre-op diet.
4. Special Considerations. If you are an individual living with diabetes, please take special
precautions when you start your pre-operative regimen. You should check your blood sugar at least four times per day and adjust your medications accordingly. Due to the reduced carbohydrate content, you may need to reduce your diabetes/blood sugar medications by up to ½ and notify your physician who monitors you.
I. WHAT IS LOW BLOOD GLUCOSE?
According to Diabetes Canada (www.diabetes.ca), when the amount of blood glucose (sugar in your blood) has dropped below 4 mmol/L. It is also called hypoglycemia. This particular blood sugar level may also have you feeling:
Shaky, light-headed, nauseous Nervous, irritable, anxious Confused, unable to concentrate Hungry
Your heart rate is faster Sweaty, headachy Weak, drowsy
A numbness or tingling in your tongue or lips
Become confused and disoriented Lose consciousness
Have a seizure
II. HOW DO I TREAT LOW BLOOD GLUCOSE?
As per the Diabetes Canada guidelines (www.diabetes.ca), if you check your blood sugars and you are truly below 4mmol/L, you must eat or drink a fast-acting carbohydrate (select only ONE):
15 g of glucose in the form of glucose tablets (preferred choice, for example 4 DEX-4 tablets) 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
175 mL (3/4 cup) of juice or regular soft drink 6 Life Savers® (1=2.5 g of carbohydrate) 15 mL (1 tablespoon) of honey
Note: Most individuals prefer to invest in the glucose tabs as they are convenient, not at risk of early expiry, require no planning, and typically contribute the least amount of calories to correct a low blood sugar versus an alternative treatment option.
Wait 10 to 15 minutes and then check your blood glucose again. If your blood sugar is: Still less than 4mmol/L, treat again
Greater than or equal to 4mmol/L, consume a nutritious intake (i.e. SmartShape ShakeTM) within 60minutes
If you are encountering repeat low blood sugar episodes, you should follow up directly with your health care practitioner who manages your diabetes medications as there is an immediate need to adjust the prescription. Also, be cautious and safe; do not operate heavy machinery after experiencing high or low blood sugars.
Serving and Calories of Raw or Steamed/Boiled Vegetables (Maximum 250 calories per day)
Please note that manipulating foods (i.e. cooking) alters their glycemic index and glycemic load values per serving; therefore, it is essential that you take into consideration how many servings you plan to consume and whether the item is in its raw or cooked form. Refrain from cooking things into a sauce, puree or soup unless you account for the larger number of servings this type of preparation process would require.
VEGETABLE VOLUME SERVING SIZE WEIGHT (g) CALORIES (KCAL)
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
Zucchini, raw 250mL 119 20
VEGETABLE VOLUME SERVING SIZE WEIGHT (g) CALORIES (KCAL)
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 VOLUME SERVING SIZE WEIGHT (g) CALORIES (KCAL)
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
Pre-Op Regime Side Effects
HUNGEREnsure to consume:
All 3 meal replacements daily; aim to have them at regular meal times. If this does not work, consider making the 3 meal replacements into 6 mini shakes taken evenly throughout the day
Up to 250 calories of the specific vegetables All supplements daily
Adequate fluid for hydration (2.5 – 3 liters per day)
Do not consume / nibble on items outside the regime, it makes hunger (and other pre-op symptoms) worse and may send you back to pre-op day 1.
Be patient. Symptoms subside within 3 – 5 days of starting regime.
Consider not preparing food for others and/or eating in the company of others, if you think it will be challenging for you to continue your pre-op regime.
HEADACHE
Ensure to consume:
All 3 meal replacements daily; aim to have them at regular meal times Up to 250 calories of the specific vegetables
All supplements daily
Adequate fluid for hydration (2.5 – 3 liters per day)
Be patient! Symptoms subside within 3 – 5 days of starting regime. Consider taking regular Tylenol for symptom relief.
Note: reducing your caffeine intake can cause headaches, which is best tackled in pre-op than post-op. DIARRHEA
Give your body time to adapt to this drastic change in diet
Opt for a variety of vegetables as they offer fiber, which can improve stool consistency
Increase fluid intake to make up for losses and ensure you stay well hydrated
Consider the addition of a fiber supplement such as Inulin (ie. Benefibre) or Psyllium (ie. Metamucil). If you can find it, we prefer sugar-free fiber supplementsNAUSEA
Do not take supplements or medications on an empty stomach Try consuming liquid shake with solid vegetables
Remain upright during and after intakes
Post-Operative Guidelines
As you recover from your procedure, we recommend a gradual process where you will be introduced to foods of increasing texture and density. These foods will be introduced in defined stages that will minimize the risk of blockage and vomiting. It is very important that you follow these guidelines in order to give your stomach time to heal and achieve maximum benefit.
In order to achieve your desired outcome and weight loss, you need to be an active participant in your care. You should intentionally choose a smaller portion of food than you are used to. Careful consideration should be given to the quality of food you eat to help you feel full.
The overall strategy is to feel a sense of satiety with the smaller portion of food. With the MGB, the goal is to feel satisfied with a small portion of good quality food.
“20:20” Rule
It is very important that you focus on chewing your food well and eating slowly. Each bite of food should be chewed at least 20 times and each meal should last at least 20 minutes. Many individuals prefer to eat protein-based foods first in case early satiety kicks in before you has a chance to consume it. Then consume vegetables followed by grain products or starchy foods.
“45 Seconds” Rule
Patients should wait a minimum of 45 seconds between a swallow of solid food and sip of a liquid beverage. High calorie liquids such as ice cream, milkshakes, chocolate, milk, fruit juices and alcohol will provide you with plenty of calories, but will not contribute to satiety and may upset your stomach.
It is important to minimize the amount of air you ingest. Avoid using a straw, consuming carbonated beverages, and/or gulping/chugging.
Vomiting
By adhering to this progressive plan we are confident that the risk of vomiting can be minimized. Helpful Items
For meal preparation For medications
- Mini food processor/food chopper - pill crusher
- Hand Blender or the “Magic Bullet” - large pill case (1week worth) - Measuring spoons and cups
Other items
- Baby spoon, cocktail fork (helps you to take small bites)
- Small decorative plates (helps control portions and increases the eye appeal of the meal) - Insulated dish or warming plate (helps keep food warm while you slowly enjoy your meal) - Sipping cup (for those that have difficulty breaking the habit of gulping liquids)
- Small freezer bags - Small plastic containers
- The FoodSaver™ to vacuum pack foods Anticipated Progression Schedule
It is important not to advance the progression of food from one stage to the next too quickly. It is safer to go slow in the advancement of your textures. Some patients may take longer than others to progress from one stage to the next. If you have any concerns about being able to tolerate the next stage, consult the clinic staff.
TIMELINE DIETARY CONSISTENCY*
Day of surgery (Day 0) Water only
First Day After Surgery (Day 1) Clear fluids only
Week 1 (Days 2-7) Full fluids including SmartShape™ Shake
Week 2 (Days 8-14) Pureed foods
Week 3 (Days 15-20) Soft foods
Week 4+ (Day 21 and beyond) Solid foods
DAY OF SURGERY
For the first 24 hours after surgery, please drink water only. DAY 1 - CLEAR FLUIDS
START DATE: Day 1 – first day after surgery END DATE: Day 1
Clear Fluids
Low-calorie, low-acid fruit juices, such as apple, grape or cranberry Decaffeinated coffee or tea
Fat-free clear broth or soup
Low-calorie Jell-O (avoid pre-made) Sugar-free popsicle
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
STAGE | FULL FLUIDS (INCLUDING SMARTSHAPE SHAKES)
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 Thinned 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)
Miscellaneous Sugar-free popsicles
GOALS
• 1.5L - 2L of fluid per day
• 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
•You may resume your regular medication when you get home. Crush/open or take liquid form for the first three days post op. After three days you should be able to tolerate your medications in solid form.
•We recommend you discuss all of your current medications with your family MD/pharmacist as the absorption of certain medications may be altered post operatively due to the 'bypass' of the first 1/3 of your small intestine
•Consult with your pharmacist if you have any questions about crushing or opening medication
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, thinned**
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, thinned 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, thinned** ½ -cup protein shake
** OPPORTUNITY TO ADD PROTEIN POWDER (SEE PROTEIN SECTION OF THIS GUIDE)
Dehydration Assistance Tool
When you are drinking enough fluids, your body is in balance and your urine may be a pale straw yellow color. When you do not drink enough fluids, your kidneys try to save as much water as they can and cause your urine to be darker in color (more concentrated).
Dark yellow-brown urine is a sign that you are dehydrated and that you should drink more fluids to prevent dehydration. Your fluid intake goal is to make your urine, no darker than the color # 3, on the chart. The darker colors (4-8) are signs of dehydration and may cause you to become ill.
Note: Certain vitamins and medications can change your urine color. If you are concerned about hydration levels, contact your physician for follow-up.
REFERENCE:
STAGE | PUREE FOODS
START DATE: Day 8 END DATE: Day 14 - the full day
You may be able to eat the same foods the rest of your family is eating by using a blender or food processor to puree it. Everything you eat at this stage must be pureed or blended (no chunks). If you eat foods that have not been pureed, it may cause an obstruction which can lead to serious complications.
Initially, you may not be able to eat all of the items recommended in the meals below. Listen to your body. Start with 1 oz (2 tbsp) portions and gradually include more pureed food at each meal. You should stop eating if you feel discomfort or pressure when eating.
How to Puree Your Foods
Step 1 - Cut food into small pieces about the size of your thumbnail Step 2 - Use ice cube trays as a measure of 2 ounces of food
Step 3 - Place food in the blender
Step 4 - Add enough liquid (fat free chicken broth or fat free gravy) to cover the blades Step 5 - Blend until smooth like applesauce or baby food
Step 6 - Strain out the lumps, seeds or pieces of food Step 7 - Use spices and herbs to flavor food
Helpful Hints
Remove seeds, skins and fat before putting food into blender Other liquid options include water, skim milk, strained low-fat soup
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) • Aim for at least 60 - 80 grams of protein per day
GUIDELINES
• Progress to this stage when full fluids are going down without intolerance • Consider baby food for ease and convenience
If you have left over pureed foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags
Very lean and dry meats puree better by adding a small amount of ‘healthy’ fat (margarine, oil, light mayonnaise, gravy, etc.), or small amounts of lemon juice or light mayonnaise Try pureed peas, canned beans or sweet potatoes
Starches puree better when hot
Rice and potatoes tend to puree into a gummy paste and are not recommended Pasta or noodles are not recommended as they are not well-tolerated
Fresh vegetables are much better than canned
If using canned fruit, drain first then add a few drops of lemon juice to help prevent them from discoloring
Add melted margarine or a small amount of liquid to help reach the smooth applesauce consistency
LIST OF ACCEPTABLE FOODS DURING THIS STAGE
Food Group Food Choices
Meat & Meat Alternatives Pureed soft poached eggs or pureed 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 pureed 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 pureed 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 alcohol
NOTE: All food and beverages listed in the full fluid dietary stage are still considered acceptable in the puree stage.
3 DAY SAMPLE MENU
BREAKFAST 8am ½-cup cooked pureed cereal made
with ½-cup skim milk
½-cup unsweetened applesauce ½-cup non-fat pureed cottage cheese
1 poached, pureed 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
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 pureed 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
STAGE | SOFT FOODS
START DATE: Day 15 END DATE: Day 20 - the full day
The soft food stage often refers to items that are easily cut or “broken” under the pressure of one’s fork; therefore, it eliminates foods that are hard to chew and swallow, including raw fruits and vegetables, chewy breads, and tough meats.
The soft food stage prepares you for solid foods. Initially, you may not be able to eat all of the items recommended in the meals below. Gradually increase your portions as the days go by. In general, you should be limited to 1cup (1side plate) of food per meal.
Remember to chew your food very well and eat slowly. Choose protein and fibre at each meal and snack to provide nutrition and help with satiety. The best sources of protein are lean meats, poultry, seafood, fish, eggs, dairy products, beans and lentils.
Stop after the described portion and begin to check for a feeling of satiety (also referred to as the absent feeling of hunger). If you feel full, pressure or any sense of discomfort you may have eaten too much. These are signs that you are eating too quickly or your stomach is full – slow down your pace of eating or stop eating the rest of your meal to avoid feeling unwell.
GOALS
• 2.5L - 3L of fluid per day
• 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 • Aim for at least 60 - 80 grams of protein per day
GUIDELINES
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
STAGE | SOLID FOODS
SmartShape™ offers detailed educational sessions via webinar to expand on the recommended nutrition regime from this point forward. To review upcoming webinars and register, visit the Events Calendar on our website.
It is very important that you chew your food very well and eat very slowly. Initially, you may not be able to eat all of the items suggested in the meals below. Gradually increase your portions as the days go by. Generally, you should be limited to 6-8 inch diameter side plate of food per meal. You may not be able to eat this entire portion at one time at this stage. You can split this portion in half and eat smaller meals through the day.
Additional Instructions
Introduce solid foods one at a time.
Limit use of butter, margarine, mayonnaise, oil, gravy, cream, jam, jelly, honey and table sugar. Bake, boil, barbecue or broil food.
Remember to take your supplements. Stay well hydrated.
Suggestions
First Try… Then Try…
Casseroles – no hard vegetables or crunchy
toppings Tender moist meats, sliced thinly
Homemade soups or well-cooked stews Any other food not yet tried Ground meat
Minced chicken/turkey Crackers
Note: Raw fruit and vegetables and sliced meats should be tried only after you are tolerating a wide variety of foods.
Some individuals may find the following foods difficult to tolerate: White bread or un-toasted bread, pasta or rice
Red meat such as beef or pork Dry meat, poultry or fish Skin of poultry or fish
Membrane, core, seeds or skins of fruits and vegetables Fibrous vegetables (corn, celery, asparagus, pineapple) Dried fruits, nuts, popcorn or coconut
Fried foods or foods high in fat Chili or other highly seasoned foods Reheated or microwaveable foods
Potential Nutrition Complications After MGB Surgery
COMPLICATION DESCRIPTION ACTION / REMEDY
Nausea, vomiting,
stomach pain May be a result of surgery itself or may be behavior induced
Do not speed up diet progression Eat slowly
Chew foods thoroughly
Avoid drinking large volumes at meal times Reduce portion per meal
Unless otherwise indicated on prescription, take supplements and medications after eating
Consider over-the-counter products (ie. non-drowsy Gravol, Pepto-Bismol)
Dehydration Dark urine, less urine output, dry mouth and tongue, tiredness, dizziness, lower back pain
Drink a min of 2L per day
Sip constantly throughout the day; consider a 15 min reminder routine
Suck on ice chips
Carry portable water bottle Dumping
syndrome / diarrhea
Soft or liquid stool
Cramping, bloating, nausea, loose stool, feeling faint, increased heart rate Symptoms typically present 10 – 90 minutes after eating and can last up to 3 hours
Avoid sugars and sweets
Avoid foods/fluids with “added sugar” in the first 3 ingredients on the label
Choose products with less than 5g of sugar per serving Avoid fatty foods, caffeine, alcohol, spicy food
Eat protein & fibre at each meal and snack Consider stool thickening foods to diet; bananas,
applesauce, legumes, or oatmeal
Drink largest fluid volumes between meals Drink more water to make up for the losses Gas Cramping, bloating, pain in lower back,
abdomen, shoulder
Avoid carbonated beverages, straws, gulping / chugging, skipping meals, chewing gum Eat slowly
Chew food thoroughly
Be mindful of beans, lentils, legumes, broccoli, cauliflower
APPENDIX 1 | SUPPLEMENT REGIME SCHEDULE*
MANDATORY LIFELONG SUPPLEMENTS
VITAMIN/ MINERAL
FORM
SOURCE RECOMMENDED DOSE & TIMING PRE-OP POST-OP DAYS 2-20 POST-OP DAYS 21& BEYOND
OPTION 1
Opurity Bypass &Sleeve Optimized Chewable
Chewable Chewable Chewable/**Capsule • 1-800-517-5111 or www.opurity.com • 1 chewable tablet per day • After breakfast AND
Calcium Citrate Solid Chewable/Liquid Solid
• Local pharmacy • 2-3 times per day; divide into 500mg maximum doses each time o After Lunch 500 mg o Mid Afternoon 500mg o After Dinner 500mg
~ OR ~
OPTION 2
Celebrate Vitamins Multi Essential 2-in-1 ChewableChewable Chewable Chewable/**Capsule
• www.celebratevitamins.ca • 2 chewable tablets, twice per day o After Breakfast 2 chewable tablets o After Lunch 2 chewable tablets AND Iron (Ferrous Sulfate is preferred; Ferrous Fumerate or Gluconate can be used as well)
Solid Chewable/Liquid Solid
• Local pharmacy o After Dinner 50 mg per day
• Take with 250-500 mg Vitamin C for better absorption
• Do not take within 2 hours of calcium foods/liquids or chewable multivitamin
*Special note for women of childbearing age: Bariatric supplements may contain some vitamin levels considered inappropriate for
pregnancy. If you plan to become pregnant (it is recommended to wait 12-18 months after surgery), please discuss your current bariatric supplement regime with your GP/OB prior to becoming pregnant and follow their recommendations for supplements during pregnancy. **Once you are able to tolerate capsules you may if you choose take our recommended supplements in capsule form. PLEASE CONTACT THE CLINIC FOR PROPER DOSAGING IF YOU CHOOSE TO SWITCH TO CAPSULES AS THE DOSAGES ARE DIFFERENT THAN THE ABOVE
APPENDIX 2 | Pre-Op Regimen Recipes
The pre-op regimen is a challenging one! However, by varying the way you flavor and cook the low glycemic vegetables outlined in the Food Guide, as well as your shakes, you can deceive your mind and body into thinking that you are having an assortment of exquisite indulgences!
Although there are pre-determined serving sizes outlined for each recipe, recall that in a single day, you are not to exceed the 250 calorie maximum for your total vegetable intake. Your serving size will look very different than what the recipe describes as a typical serving. The great thing about making extra is that leftovers can be used in the future for meals and snacks, which significantly cuts down on time spent planning and preparing food. These recipes are quick and easy, modified to make you feel satiated and will surely tantalize your taste buds.
Chocolate & Orange Shake
Cinnamon Apple Shake
INGREDIENTS10 – 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
INGREDIENTS1 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.
Recipe reference: kitchenparade.com
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
Recipe reference: kitchenparade.com
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
Recipe reference: kitchenparade.com
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
Recipe reference: about.com
BBQ Grilled Vegetables in Foil
INGREDIENTS 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
Recipe reference: kitchenparade.com
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
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 Salad
INGREDIENTS 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.
Recipe reference: allrecipes.com
Thirst 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!
