Download Bariatric Surgery - Mountain States Health Alliance

Bariatric Surgery
Nutrition Handbook
Gastric Bypass and Gastric Sleeve
TABLE OF CONTENTS Pre-Bariatric Surgery Diet
3
Choosing a Protein Supplement
5
Vitamin and Mineral Needs
6
Diet Stages Overview
7
Stage 1 Clear Liquids
8
Stage 2 Low Fat Full Liquids
9
Stage 3 Soft/Pureed Protein Foods
11
Stage 4 Soft Low-Protein Foods
13
Stage 5 Healthy Solid Foods
15
Label Reading
18
Dumping Syndrome
20
Tips for Success
21
Resources and References
22
PRE-­‐BARIATRIC SURGERY DIET 2 A Liquid Diet before Bariatric Surgery
Ten days before your surgery you will need to consume only a liquid diet. This diet will
cause rapid weight loss and also help reduce the size of your liver, making the procedure
easier to perform and safer for you. The specific details of this diet will be given to you by
your surgeon and reviewed by your nutritionist in your nutrition class.
During this time, it is important to include a protein supplement several times each day to
improve your nutrition before surgery. Your goal is 60-80 grams of protein each day.
Some are pre-mixed and others are powder that requires mixing with fat-free milk or
water. Please make sure you read the label on the supplement. You want to choose one that
has a high amount of protein and a low amount of sugar and calories.
Patients with diabetes that are taking oral diabetes medication and/or insulin should
discuss the pre-surgery diet with the doctor that manages your diabetes. You may also
choose to use products that are not low carbohydrate versions. Consume 15 grams of
carbohydrate ever 1-2 hours to help prevent hypoglycemia. Make sure to monitor your
blood sugar more closely as this is a very drastic change in your diet. Call your doctor if
you are experiencing high or low blood sugars.
The following page has a chart for you to use to track the foods and beverage you consume
during this 10 day period. You will be consuming low and no calorie clear liquids and low
fat, low calorie, no sugar added full liquids and a protein supplement.
Clear Liquids
Water
Diluted juices (fruit or vegetable)
Broth based soups
Gatorade or generic equivalent
Sugar free flavored water
Unsweetened tea
Unsweetened coffee
Crystal light
Sugar free Gelatin
Sugar free popsicles
Full liquids
Low fat, no sugar added yogurt
Skim milk
Low fat cottage cheese
3 4 CHOOSING A PROTEIN SUPPLEMENT While you are following the liquid diet prior to surgery and when you begin Stage 2 Low Fat Full
Liquids you will need to drink a protein supplement. The supplement will need to be continued
throughout the remaining stages of your diet in order to meet your protein needs. However once
you are able to consume enough protein from foods at meal times you will no longer need a
supplement. There are several to choose from and guidelines are provided to help you make your
choice.
Choose a ready to drink protein supplement or powdered protein supplement that contains:
▪
Protein from whey, casein, egg whites, milk or soy. Avoid collagen or hydrolyzed gelatin.
▪
Less than 200 calories per serving.
▪
Less than 25 grams of sugar per serving.
▪
At least 15-20 grams but no more than 30 grams of protein per serving.
Some brand names available:
Brand
Slim Fast High Protein
Atkins Shake
Boost Glucose Control
Pure Protein
Isopure Plus
Non-fat dry milk powder
Pure Protein
Syntrax Nectar
Isopure Zero Carb
Unflavored
Unjury Unflavored
Amount
Protein (g)
Calories
Ready to Drink Protein Supplement
10 ounces
20
180
11 ounces
15
160
8 ounces
16
190
11 ounces
23
120
8 ounces
15
60
Powdered Protein Supplement
⅓ cup
8
80
1 scoop
20
110
1 scoop
23
100
Sugar (g)
2
1
4
1
0
12
1
0
1 scoop
26
110
0
1 scoop
21
90
0
5 VITAMIN AND MINERAL NEEDS Begin taking vitamin and mineral supplements with the Pre-Bariatric Surgery Diet. You will stop
taking them the day before surgery but will start back during Stage 2 of the diet. All of the required
supplements are listed below. They are available over the counter at your local pharmacy.
You will need to take these supplements every day from the start of stage 2 and for the rest of your life. Please remember that for the first TWO MONTHS you may not swallow a whole pill. MULTIVITAMIN AND MINERAL SUPPLEMENT Amount and Type: We recommend Flinstones Complete, chew 2 once a day OR Centrum
Chewable, chew one tablet.
How often: Every day
When: In the morning with breakfast
VITAMIN B12 You will get a B12 injection before you leave the hospital and it lasts one month. After that you
have these options:
Amount and Type: 500 mcg sublingual daily or 1000 mcg every other day, nasal supplement
weekly or 1000 mcg injectable once a month. The sublingual form is over the counter. If you
prefer one of the other methods, you will need a prescription from your doctor.
When: Oral type in the morning with breakfast
CALCIUM CITRATE WITH VITAMIN D Amount and Type: Citrical Plus D3, chew one tablet with lunch and one with dinner.
How often: One twice a day
When: With lunch and dinner (Calcium should not be taken with iron or your multi vitamin as the
absorption will be decreased).
DO NOT PURCHASE ANY SUPPLEMENT THAT IS IN A GUM FORM. GUMMY
CHEWABLES CAN BLOCK THE PASSAGE TO YOUR NEW STOMACH.
ELEMENTAL IRON The need for iron supplementation varies by patient and type of surgery. Consult the physician
that is following your lab values.
6 DIET STAGES OVERVIEW
Your diet after surgery is important for successful weight loss. Your stomach is significantly
smaller than before surgery and will limit the amount of food you are able to consume helping with
weight loss.
The nutrition prescription outlined below helps you in the following ways:
1. Preventing nausea, vomiting, and abdominal pain due to stomach blockage or stretching of
your stomach.
2. Achieving and maintaining your desired weight loss.
Your diet after surgery consists of five specific stages.
Each step is described in detail on the following pages.
Stage 1
Day 1 in hospital
Day 2 in hospital
Stage 2
Stage 3
Day 3 – 14
home
Week 3
at
Clear Liquids
Low Fat
Full Liquids
Low Fat
Full Liquids
Soft/Pureed
Protein Foods
!
!
!
!
!
!
!
!
Stage 4
Stage 5
Week 4
Week 6
and beyond
Soft
LowProtein Foods
!
Healthy
Solid Foods
!
!
!
Three 1 ounce servings per meal.
Three 1 ounce servings per meal plus
no sugar added Mighty Shake
Between meals drink 2 ounces of
liquid every 15 minutes.
Goal is 48 ounces each day.
Add soft, pureed, high-protein foods
to liquid diet.
Increase liquids to 48-64 ounces each
day.
Consume 4-6 meals/day
(1/4
cup each meal).
Add well-cooked vegetables,
soft/canned fruits.
Consume 4-6 meals/day
(1/2 cup each meal).
Eat a balanced diet.
Avoid raw/fibrous fruits and
vegetables.
Consume 3 meals and 2 snacks
(1 cup each meal).
TIME OF DIET ADVANCEMENT IS APPROXIMATE AND BASED ON YOUR TOLERANCE. YOUR DOCTOR MAY ADJUST THE TIME AS NEEDED. 7 STAGE 1 CLEAR LIQUIDS DAY 1 This stage begins in the hospital and consists of sugar free, caffeine-free,
carbonated beverages.
•
Clear liquids begin after the gastrograffin study (leak test).
•
You will receive three 1 ounce portions of clear liquids at each meal.
•
Drink 1 ounce slowly over 15 minutes.
•
Take small sips and be aware of feeling full.
•
Avoid drinking from straw to reduce air intake.
non-
Stage 1 foods include:
•
•
•
•
Broths – Chicken, Beef or Vegetable
Juice – Apple or Grape
Sugar Free Popsicles
Sugar Free Gelatin
STAGE 1 CLEAR LIQUIDS SAMPLE MENU
Breakfast
Lunch
Dinner
1 ounce vegetable broth
1 ounce sugar free gelatin
1 ounce apple juice
1 ounce beef broth
1 ounce sugar free gelatin
1 ounce sugar free popsicle
1 ounce chicken broth
1 ounce sugar free gelatin
1 ounce grape juice
8 STAGE 2 ADD LOW FAT FULL LIQUIDS DAY 2 -­‐ 14 Stage 2 begins the second day after surgery and continues until day 14.
•
This diet stage is a combination of Clear Liquids and Full Liquids with the addition of your
protein supplement.
•
While in the hospital you will receive three 1 ounce portions of full liquids at each meal.
Slowly increase the volume of full liquids at each meal to a maximum of 3 ounces.
•
Be sure to stay hydrated by drinking 6-8 cups fluid each day between meals. You will need to
drink small sips of water or sugar free, non-carbonated beverages throughout the day.
Drink 1-2 ounces over 15 minutes. Do not drink more than 8 oz. fluids in one hour.
•
Resume your chewable multivitamin, calcium citrate, Vitamin B12 and iron supplement.
•
Your protein intake goal is 60-80 grams of protein/day.
•
In the hospital, you will receive No Sugar Added Mighty Shakes to meet your protein needs.
When you are at home drink protein-containing liquids and your protein supplement to
meet you protein intake goal.
Sugar free,
non-carbonated Clear Liquids
Protein Containing Full Liquids
Amount
Food
Protein (g)
Water
8 ounces
Skim milk
8
Decaffeinated Coffee
13
Decaffeinated Tea
16
Broth
6
Crystal Light
8
Sugar free Kool-Aid
6
Sugar free gelatin
4
Sugar free popsicles
8 ounces
No sugar added Carnation Instant
Breakfast packet
mixed
with skim milk
Skim Milk mixed with ⅓ cup nonfat dry milk powder
Soy milk
6 ounces
Sugar free plain or vanilla yogurt
8 ounces
8 ounces
8 ounces
4 ounces
Strained condensed low fat cream
soup made with skim milk
Sugar-free, fat-free pudding
100% fruit juice (no sugar added)
9 STAGE 2 LOW FAT FULL LIQUIDS SAMPLE MENU Breakfast
Lunch
Dinner
1 ounce no sugar added
vanilla yogurt
1 ounce apple juice
1 ounce skim milk
1 ounce strained cream of
chick soup
1 ounce grape juice
1 ounce sugar-free pudding
1 ounce tomato soup
After Breakfast
8 ounces protein drink
consumed over 1-2 hours
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
After Lunch
8 ounces protein drink
consumed over 1-2 hours
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
1 ounce apple juice
1 ounce no sugar added
vanilla yogurt
After Dinner
8 ounces protein drink
consumed over 1-2 hours
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Take your vitamin and mineral supplements.
10 STAGE 3 ADD SOFT/PUREED PROTEIN FOODS DAY 15-­‐21 Stage 3 begins approximately 2 weeks after surgery and continues for 1 week.
•
At this stage, you can slowly begin to replace full liquids with soft, moist, pureed, highprotein foods.
•
Consume 4-6 small meals throughout the day. Each meal should be ¼ cup.
•
Consume protein first with the goal of 60-80 grams of protein per day.
•
Eat slowly - each meal should take 30-45 minutes to finish.
•
Chew thoroughly – swallowing chunks may cause stomach blockage.
•
Avoid drinking 30 minutes before and 30 minutes after a meal.
•
Increase clear liquids to 48-64 ounces each day.
•
Limit high-fat, high-sugar foods as they may cause nausea.
•
Add foods to your diet one at a time.
•
Avoid extremes in food temperatures - very hot or very cold foods may cause spasms or
cramps.
•
Avoid tough meats, hot dogs, bologna, bacon, sausage, peanut butter.
Food
Scrambled Egg
Canned tuna - in water
White meat chicken or turkey
Low-fat/fat-free cottage cheese
Low-fat/fat-free ricotta cheese
Low-fat/fat-free mozzarella cheese
Non-fat dry milk
No sugar added/light yogurt
Sugar-free/fat-free pudding
Portion
Protein (grams)
1
1 ounce
1 ounce
½ cup
¼ cup
1 ounce
1/3 cup
6 ounces
½ cup
8
7
7
12
8
8
8
6
4
11 STAGE 3 SOFT/PUREED PROTEIN FOODS SAMPLE MENU
Breakfast
Lunch
Dinner
¼ cup Scrambled eggs
30 minutes after Breakfast
8 ounces protein drink
consumed over 1-2 hours
¼ cup Pureed Turkey
30 minutes after Lunch
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Afternoon Snack
¼ cup Tuna with light
mayonnaise
30 minutes after Snack
8 ounces protein drink
consumed over 1-2 hours
¼ cup Pureed chicken
30 minutes after Dinner
8 ounces protein drink
consumed over 1-2 hours
Morning Snack
¼ cup Cottage Cheese
30 minutes after Snack
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Evening Snack
¼ cup no sugar added yogurt
30 minutes after Snack
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Take your vitamin and mineral supplements.
12 STAGE 4 ADD SOFT LOW-­‐PROTEIN FOODS DAY 22-­‐35 This stage begins approximately 3 weeks after surgery. Continue stage 3 foods
and slowly add soft low-protein foods to your diet.
•
Continue consuming 4-6 small meals per day. Each meal should be ½ cup.
•
Continue keeping liquids and solids separated.
•
Pay attention to your body’s feelings of fullness and stop eating when you begin to feel full.
Take your vitamin and mineral supplements.
Foods Allowed
Grains/Starches
Cream of rice
Low-fat crackers
Mashed low-fat potatoes without skin
Cream of wheat
Oatmeal
Low-fat tortilla
Malt-o-meal
Corn/rice based cereals (Corn Flakes, Rice
Krispies, Special K, Kix, Cheerios)
Foods to Avoid
Bread
Pasta
Sweetened cereal
Sweet rolls
Croissants
High-fat crackers
Sweet breads with nuts/dried fruit
Hash browns
Rice
Granola
High-fiber cereal
Doughnuts
Popcorn
French fries
Vegetables
Tender-cooked vegetables
Carrots, broccoli, cauliflower, green beans,
etc.
Tomato juice (<8 oz./day)
Foods Allowed
Fruits
Tender fruits
Bananas, cantaloupe, honeydew
Unsweetened soft, canned fruits
Unsweetened applesauce
Miscellaneous
Corn, celery, peas, lettuce, stringy
vegetables
Fried vegetables
Vegetables in cheese sauces
Vegetables with tough skins or large seeds
Foods to Avoid
Dried Fruits
Fruit juice
Fruits canned in heavy syrup
Fruits with tough skins, shells, or large seeds
13 Low-fat salad dressings
“light” fruit juices
Pies, cookies, cakes
Sweetened/carbonated drinks
Jellies/candy/chocolate
Potato/corn chips
Ice cream
STAGE 4 SOFT LOW-­‐PROTEIN FOODS SAMPLE MENU
Breakfast
Lunch
Dinner
¼ cup Scrambled eggs
¼ cup Oatmeal
30 minutes after Breakfast
8 ounces protein drink
consumed over 1-2 hours
¼ cup Pureed Turkey
¼ cup green beans
30 minutes after Lunch
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Afternoon Snack
¼ cup Tuna with light
mayonnaise
1 low fat crackers
30 minutes after Snack
8 ounces protein drink
consumed over 1-2 hours
¼ cup Pureed chicken
¼ cup mashed potatoes
30 minutes after Dinner
8 ounces protein drink
consumed over 1-2 hours
Morning Snack
¼ cup Cottage Cheese
¼ cup canned peaches
30 minutes after Snack
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Evening Snack
¼ cup no sugar added yogurt
¼ cup ripe cantaloupe
30 minutes after Snack
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
14 STAGE 5 HEALTHY SOLID FOODS DAY 36 Stage 4 begins approximately 6 weeks after surgery and is the diet you will continue
to consume to promote weight loss and maintain your nutritional health.
•
Continue with stage 4 foods and introduce one food at a time from the list below. By adding
foods gradually, you will notice if any particular food causes nausea.
•
All foods in this stage should be low-fat, low in sugar, with a variety of fruits, vegetables and
whole grains, and provide 60-80 grams of protein per day.
•
Food intolerances are individual and often temporary. Keep track of foods that bother you
and wait 2-3 weeks before introducing them again.
•
Avoid distractions while eating (TV, reading, etc.).
•
Chew foods to a pureed consistency before swallowing.
•
Continue to keep solid foods separated from liquids with meals.
Take your vitamin and mineral supplements .
Foods Allowed
Meat/Dairy/Protein
Scrambled/poached eggs
Egg whites
White meat chicken
White meat turkey
Broiled/baked fish
Deli meats- low-fat
Skim or 1% milk
Sugar Free Carnation Instant Breakfast
Soy milk
Fat-free half & half
Low-fat sour cream
Light yogurt w/o seeds
Sugar free pudding
Low-fat cheeses
Low-fat cottage cheese
Foods Allowed
Meat/Dairy/Protein continued
Low-fat cream cheese
Low-fat cream soups
Low-lactose/lactose-free skim milk (if
lactose intolerant
Foods to Avoid
Tough meats- roast beef, steaks, pork chops,
roast pork
Fried meats
Hot dogs
Bologna
Sausage
Bacon
Spare ribs
Regular cheese
Peanut butter/nuts
Whole/2% milk
Chocolate milk
Regular milkshakes, frappes, eggnog
Half & half
Regular sour cream
Foods to Avoid
Regular yogurt
Regular pudding
Regular cheeses
Regular cream soups
15 Heavy cream
Breads/Grains/Starches
Malt-O-Meal
Cream of wheat
Cream of rice
Oatmeal
Corn/rice-based cereals (corn flakes, Kix,
Cheerios, Rice Krispies, Special K)
Low-fat crackers
Low-fat tortilla
Mashed, low-fat potato
Baked potato without skin
Pasta
Toast
Low-fat popcorn- chewed thoroughly
Vegetables
Any soft-cooked, plain vegetable
Tomato juice (<8 oz./day)
Reintroduce salad and raw vegetables
slowly
Fruits
Tender fruits- bananas, cantaloupe,
honeydew
Unsweetened soft, canned fruits
Unsweetened applesauce
Fresh fruits- introduce gradually
Miscellaneous
Broth
Sugar-free gelatin
Herbs/spices
Lemon juice
Foods Allowed
Miscellaneous continued
Low-fat margarine, mayo, salad dressings
Sugar-free popsicles
Light fruit juices
Crystal light
Decaf coffee/tea
Granola
Sweet roll
Doughnuts
Croissants
Sweet breads with nuts or dried fruit
Pancakes/waffles with regular syrup
High-fat crackers
French fries
Hash browns
Macaroni and cheese
Pasta with alfredo
Butter crackers- goldfish, wheat thin, etc.
Potato chips, tortilla chips, cheese curls
Fried vegetables
Vegetables in cheese sauces
Vegetables cooked in fat or cream sauces
olives
avocados
raw vegetables with tough skins, stems, or
seeds
Fruits with tough skins, shells, or large seeds
Dried fruits
Fruits canned in heavy syrup
Fruit juice
Coconut
Cream soups/chowders
Regular gelatin
Pies
Cakes, cookies
Foods to Avoid
Butter/margarine/cream cheese/sour cream
Salad dressing
Nuts
Potato/corn chips
Chocolate/candy
Ice cream
Jam/jellies
Honey/sugar
Gravy
Alcohol
Carbonated/caffeinated drinks of any kind
16 (diet and regular)
Gatorade/Snapple/So-Be
Sweetened coffee drinks
Sweetened ice tea
STAGE 5 HEALTHY SOLID FOODS SAMPLE MENU Breakfast
Lunch
Dinner
¼ cup Scrambled eggs
½ cup oatmeal
1 slice toast
2 oz. deli meat Turkey
½ cup green beans
2 oz. low fat yogurt
2 oz. chicken
¼ cup cooked carrots
¼ cup mashed potatoes
30 minutes after Breakfast
8 ounces protein drink
consumed over 1-2 hours
30 minutes after Lunch
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Afternoon Snack
¼ cup Tuna with light
mayonnaise
3 low fat crackers
¼ cup applesauce
30 minutes after Snack
8 ounces protein drink
consumed over 1-2 hours
30 minutes after Dinner
8 ounces protein drink
consumed over 1-2 hours
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
Evening Snack
2 oz. low fat cheese
¼ ripe banana
30 minutes after Snack
8 ounces sugar free,
non-carbonated beverage
consumed over 1-2 hours
LABEL READING Many foods appear healthy but may actually contain a high amount of sugar, calories, or fat.
Although these nutrients are important, having too much in your diet can cause weight gain. When
choosing a food, read through the ingredients and Nutrition Facts for a description.
Serving Size
Look at the number of servings in a package. The amount of calories, fat, and sugar on the
nutrition facts label is only for one serving. Many packages contain more than one serving.
Calories
This number is the total calories in one serving of the food. When you advance to stage 4, meals
should be 300-400 calories each. Snacks between meals should be 100-200 calories.
Total Fat
For optimal health, limit your overall fat and choose healthier fats. Saturated and trans-fats
(animal products, hydrogenated oils) are linked to heart disease and should be limited. Look for
17 polyunsaturated and monounsaturated fats (olive and canola oil) which are better choices. Low-fat
foods contain 3 grams fat/100 calories or less.
Total Carbohydrate
Carbohydrates include natural sugar, added sugars, fiber, and sugar alcohols. While added sugars
may cause dumping syndrome, fiber passes through your body and helps to prevent constipation.
Choose foods high in fiber when you are on solid foods, but chew all fiber-containing foods
thoroughly.
Protein
Since your protein goal is 60-80 grams/day, try to have 20-25 grams of protein per meal. By
choosing a variety of protein foods, drinks, and snacks, you can meet this goal.
18 DUMPING SYNDROME
Dumping syndrome commonly occurs after bariatric surgery. Food that contains a high amount of
sugar, fat, or lactose may be “dumped” into the small intestine. Dumping syndrome has two phases
and can be unpleasant. If you experience either phase, determine which food caused it in order to
prevent it from happening again.
Initial Phase: 15-60 minutes after a meal
• Nausea
• Abdominal cramps
• Cold sweats
• Increased heart rate
• Flushing
• Vomiting
• Diarrhea
Latent Phase: 2-4 hours after eating
• Cold sweats
• Lightheaded/dizzy feeling
• Shakiness
• Weakness
• Hunger
The latent phase may mean that you have a low blood sugar or hypoglycemia. When you notice
latent dumping syndrome, use the 15/15 rule.
1. Consuming 15 grams of carbohydrate
Examples: 4 oz. juice, 8 oz. low-fat milk, 8-10 lifesavers
2. Wait 15 minutes
If symptoms persist, repeat the 15/15 rule. Don’t over-treat a low blood sugar as it may
cause you to “dump” again.
Troubleshooting
Not everyone experiences dumping syndrome but you may have some of the symptoms of dumping
listed above. When you notice symptoms, ask yourself the following questions:
When did I last eat?
What foods/beverages did I have?
Were those foods high in sugar, fat, or lactose (dairy)?
What was the total amount of carbohydrate in the meal?
If I had symptoms of latent dumping, did the 15/15 rule help resolve symptoms?
19 TIPS FOR SUCCESS
•
Give yourself 30-45 minutes for each meal. Take small bites and chew well before
swallowing. Notice when you start to feel full.
•
Do not drink fluids with meals. Wait at least 30-45 minutes before or after meals to drink
beverages
•
Sip on at least 48-64 oz. calorie-free and non-carbonated fluid between meals to stay
hydrated
•
Take your vitamins and minerals every day
•
If you find that you’re not losing weight, keep a record of everything you eat and drink
throughout the day.
•
Avoid temptation! At every meal, prepare your plate and then put leftovers away before you
begin to eat.
•
Buy individual portions or small packages of food to control your intake.
•
When eating at a restaurant, use the following tips to stay on track:
o Share a meal
o Avoid beverages with meals
o Avoid the bread basket
o Avoid appetizers- many are high in fat
o Choose lean meats and lighter entrees
o Avoid dips, sauces, or gravies or ask for them on the side
o Avoid buffets
o Take leftovers home
20 RESOURCES www.nih.gov (National Institutes of Health)
www.eatright.org (American Dietetic Association)
www.mayohealth.org (Mayo Clinic)
www.americanheart.org (American Heart Association)
www.diabetes.org (American Diabetes Association)
www.niddk.nih.gov/health/nutrition.htm (National Institute of
Diabetes, Digestive & Kidney Disorders)
REFERENCES Cummings, Sue, and Kellene Isom. Pocket Guide to Bariatric Surgery. 2nd ed. N.p.: Academy of
Nutrition and Dietetics, 2015. Print.
"Gastric Bypass Surgery Nutrition Handbook." Dartmouth-Hitchcock Medical Center, 23 Feb.
2005. Web. 8 Sept. 2015.
Van Nieuwenhove, Y., et. al. (2011). Preoperative Very Low-Calorie Diet and Operative Outcome
After Laparoscopic Gastric Bypass. A randomized Multicenter Study. Arch Surg, Vol. 146 (No.11).
Van wissen, J. et. al. (2015) Preoperative Methods to Reduce Liver Volume in Bariatric Surgery: a
Systematic Review. Obes Surg DOI 10.1007/s11695-015-1769-5.
21