To lose weight and reduce the size of the liver in order to limit the risk of complications during surgery.
Loss of 5 to 10% of current weight through a low-carbohydrate, low-calorie diet.
Liquid diet to follow depending on your Body Mass Index (BMI)
BMI of 35 to 40 with co-morbidity: 2 weeks;
BMI of 40 to 50: 2 weeks;
BMI of 50 to 60: 4 weeks;
BMI over 60: 6 weeks.
DAILY Liquid Diet
4 Optifast pouches/day = 900 kcal, 90 g protein/day
4 Optifast 900 pouches – vanilla or chocolate – each 54 g pouch prepared with 300 ml of cold water
Between the «Optifast meals», drink water so as to reach a total of 1.5 to 2 litres of liquids. Coffee, herbal tea or tea (no sugar) is limited to 1 to 2 cups per day.
Taking chewable vitamins and mineral supplements, such as Centrum Select, is recommended for approximately eight weeks before surgery, and while you are on a liquid-only diet. It is important to continue taking chewable Centrum Select after sur- gery for at least one or two months, i.e., during the postoperative diet period. After that, you can swallow non-chewable tablets. You are advised to take a multivitamin for at least 1 year following surgery.Include vegetables (low in carbohydrates) with each meal. The vegetables you add to complement your meals must be eaten plain, and be raw or steamed.Examples of vegetables you can eat: broccoli, cauliflower, radishes, asparagus, spinach, lettuce, cucumbers, peppers, mushrooms, tomatoes, celery, green beans.To prevent or relieve constipation, in addition to eating vegetables you may use a fibre supplement
E.g., Benefibre in powder form, which can be found in drugstores (see directions for use on the container).
If you are a diabetic, it is important to schedule an appointment with your physician to review the dosage of your medication to be taken along with your liquid diet and as you lose weight. Increase blood glucose monitoring to four times per day before each «meal» and before going to bed, to ensure better self-monitoring.
It is important to see your nutritionist at least once prior to surgery. Afterwards follow-ups are encouraged to monitor the progress in your nutrition and weight loss. Nutritional follow-ups are the key to long-term success
Have you thought about making a few changes now?
Some adjustments will need to be made to modify your eating habits following the surgery, both over the short and the long term. We encourage you to prepare yourself mentally ahead of time for changes in menu planning, purchases, and food preparation, as well as begin to apply these new practices on a daily basis. Follow the «Successful Nutrition Strategies» guide on page 21 to familiarize yourself with the basic principles to ensure the long-term success of your surgery results.
A New Life New Food AFTER surgery!
First of all, it is important to understand that, following surgery, your stomach will be very small in size. This is one of the goals of the surgery, to help you eat much smaller food portions at one time. That is why it is important to eat three meals a day, and protein snacks as needed, to obtain optimal nutritional intake and avoid slowing down your metabolism.
Following surgery, the first month is the «postoperative diet» stage. This guide describes each stage and the progression towards reaching the fifth week, i.e., the stage of more
«normal» eating. It goes without saying that each person will need to take the time they require to progress in their «postoperative diet» to encourage healthy weight loss and minimize the risk of complications. Listen to your body, follow your own pace and tolerance. You can prepare pureed and chopped food ahead of time and freeze them to make these foods available after surgery for the «postoperative diet».
In addition to reduced serving sizes, it is important to review how you shop for a supply of healthful food; you may need assistance to do your groceries. Make a habit of preparing a grocery list and dividing your list into four categories, corresponding to each of the groups in Canada’s Food Guide.
In addition, you are encouraged to limit your consumption of foods that are high in sugar, salt and fat, which are often responsible for excess pounds in a poor food diet. Instead, get your taste buds accustomed to appreciating various tastes. Be open to exploring new flavours (e.g., different vegetables and whole grains) to reap more benefits.
It will be beneficial to modify your daily activities (meal preparation, getting to work, etc.) by moving more! Every little step added to your daily routine can help.
Stay in contact with the bariatric surgery team to ensure that your lifestyle and healthful eating habits are being properly managed after surgery to minimize complication risks.
We hope your journey is a good one, particularly with regard to food, and that your health and weight loss will be optimized by targeting lifestyle changes for longterm success!
Food Protocol AFTER Surgery
To optimize loss of body fat while also improving health and minimizing loss of muscle mass.To optimize nutritional status, instil healthier lifestyles and identify strategies that will allow you to avoid surgery-related complications and to ensure long-term success. To minimize side effects and possible surgery-related discomfort (nausea, vomiting, reflux, diarrhea, food intolerance, wound infections, food blockages).
Make an appointment with your nutritionist after the surgery to follow-up on your changes in nutrition and weight.
Given that your stomach will become very small following surgery, with a capacity of approximately 60 to 125 ml (¼ cup to ½ cup), you will feel full very quickly; in other words, you will no longer be hungry. Therefore, it is very important that you avoid eating large portions that could cause you digestive discomfort.Note that the quantities indicated in this guide serve as recommendations. Do not be discouraged if you are not able to eat all of the suggested quantities.To optimize your protein intake after the surgery, add protein supplements (e.g., whey protein such as Beneprotein®). It is important to include at least six measuring scoops of powdered protein concentrate each day, i.e., one scoop per meal and per snack during stages 1, 2, 3, and 4 (see p. 8). For optimal results, mix each measuring scoop of Beneprotein® with at least 125 ml (½ cup) of liquids (diluted juice, milk, yogurt, Yop®, soup, etc.) You can mix it in the blender to obtain a homogenous consistency. As an alternative to using a protein concentrate, you can use skim milk powder (less expensive), but you must double the quantity added to obtain the same protein content.In order to stay properly hydrated, drink 1.5 to 2 litres of liquid per day, especially water, swallowing small amounts of no more than 60 ml (¼ cup) at a time. Avoid regular and diet carbonated beverages.
Right after the surgery, you can either take a sip of water or suck on an ice cube. This will be limited to 30 ml (1 oz) of water/hour.Warning: when using a straw, drink slowly and take small sips.If you are hospitalized, you will receive a clear liquid diet in small amounts and a semi- liquid diet after the operation.
NOTE: You will find important information on the differences to be considered with respect to food and supplements for each type of surgery.
Small-dose progressive diet
Stage 1(beginning the day after surgery, hence, on Day 2)
Strictly liquids Duration = 3 days
Stage 2 Semi-liquid diet Duration = 4 days
Stage 3 Soft/pureed diet Duration = 7 days
Stage 4 Soft/minced diet Duration = 14 days
Stage 5 Regular/soft diet – 60–90 g servings of meat
Diet progression – Stage 1
Day 2 to Day 4: Strict Liquid Diet (low volume)
water;clear broth;suggested fruit juice (see recipe on p. 13) protein-enriched Jello fruit gelatine (see recipe on p. 12);3 SMALL MEALS and 3 to 6 snacks, 60 to 125 ml (¼ to ½ cup).Drink 1.5 to 2 litres (six to eight cups) of liquids per day, including water, to avoid being dehydrated, maximum of 60 ml (¼ cup) at a time.Drink slowly, swallowing small amounts at a time, to avoid nausea and/or vomiting.Avoid liquids that are very cold or very hot.Avoid carbonated beverages that can cause abdominal discomfort and stretching or expansion of your small stomach.Avoid caffeine or tea.
Note: The suggested juices and enriched gelatines are to be taken for the first month, given the difficulty to attain daily protein requirement
Strawberry or another flavour
1 85 g box gelatine powder – strawberry or another flavour
1 cup boiling water
1 cup cold water
4 measuring scoops Beneprotein protein concentrate
Dissolve the gelatine powder in the boiling water. Add the cold water. Add the protein concentrate. Mix gently with a whisk, so as not to cause the mixture to become too foamy, and just until everything is well dissolved and not lumpy.
Let it stand for a few minutes so that the froth dissolves as much as possible. Portion out into half-cup – 125 ml containers and refrigerate at least two hours.
4 servings of 1/4 cup - 60 ml
Protein Enriched - HYDRATING DRINK
Protein-enriched Orange Drink
2 cups pure unsweetened orange juice 500 ml
1 cup cool water 250 ml
6 measuring scoops Beneprotein protein concentrate 6 x 30 ml
Combine all ingredients. Mix well using a whisk
Homemade - HYDRATING DRINKS
4 cups pure unsweetened apple juice salt 1L
½ tsp salt 3 ml
4 cups cool water 1L
3 cups grape juice 750ml
½ tsp salt 3ml
5 cups cool water 1.24L
Note: Choose real fruit juices, without added sugar. For the first month after the surgery, we advise using pulp-free fruit juices. Also, avoid prune juice
Diet progression - Stage 2
Day 5 to Day 8: Semi-liquid Diet
125 ml (1/2 cup) dry cereal, softened in 60 to 125 ml of milk
Corn Flakes, Spécial K, Rice Krispies
125 ml (½ cup) hot cereal Diluted oatmeal l Cream of wheat Baby cereals 60-90 minutes later,125 ml (½ cup) 2%, 1% or skim milk (with Beneprotein added) 125 ml (½ cup) suggested fruit juice
Lunch and Dinner:
l125 ml (½ cup) smooth creamed soup with Beneprotein added)60 ml (¼ cup) pureed fruit
125 ml (½ cup) milk dessert or yogurt dessert Snacks (between meals: 3 times a day)
125 ml (½ cup) suggested fruit juice (see recipe on p. 13)
125 ml (½ cup) pureed fruit (with Beneprotein® added)
Protein-enriched milk shakes (smoothies) (see p. 15)
Protein-enriched - MILK SHAKE
Soft tofu or plain or flavoured silk tofu 125 ml
½ cup Skim or 1% M.F. milk or soy milk 125 ml
½ cup Fresh or frozen mixed fruits 125 ml
2 measuring scoops Beneprotein protein concentrate 2 x 30 ml
1 tbsp Maple syrup 15 m
Place the tofu, milk, fruit and protein powder in a blender. Mix until the consistency is smooth.
You can replace the protein concentrate with ground almonds or pasteurized liquid eggs (Naturegg).
You can also add yogurt to your mixture, to increase the protein content, depending on your preference.
Preferably avoid fruit with small seeds (strawberries, blackberries).
Makes three ½ cup or 125 ml servings.
POPSICLES WITH BOOST FRUIT FLAVOURED BEVERAGE
1 container Boost fruit Flavoured Beverage 237 ml
4 Popsicle moulds, 60 ml each 4
4 measuring scoops Beneprotein protein concentrate 85 ml
Mix the Beneprotein into the Boost fruit Flavoured Beverage.
Pour one quarter of the container (approximately 60 ml) into each mould. Insert sticks and freeze until solid.
4 servings of 1/4 cup - 60 ml
INTRODUCING SOLID FOODS General Advice
Eat three small meals a day. Have at least three of the four food groups at each meal,
emphasizing protein sources.
A small meal should take you at least thirty minutes to eat.
Choose 2 to 3 healthful protein-enriched snacks a day
Eat slowly and chew your food longer, approximately fifteen to twenty times per mouthful.Pay attention to your physical signs of hunger.
To keep yourself well hydrated, drink 1.5 to 2 litres of liquid per day, especially water, in small sips, a maximum of 60 ml (¼ cup) at a time. Regular or diet carbonated beverages should be avoided.
Do not drink while eating, in order to save enough room in your stomach for nutritious solid foods. Take liquids (e.g., a drink or soup) thirty minutes before meals and 60 to 90 minutes after meals.
Avoid dry, sticky and stringy foods: nuts, popcorn, dried fruit, caramel, celery, rhubarb, corn, etc. to avoid blockages caused by food masses.
Since the cereal products recommended during the first month after surgery are quite «refined» to allow for easier digestion, this will unfortunately result in lower fibre intake. So it is a good idea to add a fibre supplement such as Benefibre to your menu.Stop eating as soon as you feel full.Do not lie down after eating, to prevent gastric reflux.As you progress through your eating stages, it is important to try one new food at a time. This way, if this food is not tolerated, you will know which food was the cause Start walking and getting other exercise as soon as possible.
Diet progression - Stage 3
Day 16 to Day 30 (weeks 3 and 4): Soft-pureed Texture Diet
Duration: approximately 1 week, from
125 ml (½ cup) dry cereal, softened in 60 to 125 ml of milk
Corn Flakes,Spécial K,Rice Krispies
125 ml (½ cup) hot cereal Oatmeal Cream of wheat Baby cereals
125 ml (½ tasse) de lait 2 %, 1 % ou écrémé (avec Beneprotein ajouté) 125 ml (½ cup) 2%, 1% or skim milk (with Beneprotein added)
125 ml (½ cup) suggested fruit juice (see recipe on p. 13) 60 to 90 minutes later
1 piece of white toast without the crust, with non-hydrogenated soft margarine 1 egg (omelette or hard boiled & mashed)
60 ml (¼ cup) fruit juice 60 to 90 minutes later
Lunch and Dinner
60 g (¼ cup) of meat, pureed chicken or poached fish with a light sauce (béchamel, tomato sauce), silk tofu or omelette (2 eggs)
90-125 ml (¼-½ cup) pureed vegetables 90-125 ml (¼-½ cup) pureed potato
Wait 60 minutes after the meal for liquids (desserts or snacks)
125 ml (½ cup) fruit* juice, skim milk or enriched milk shake (see recipe on p. 15) or 125 ml soup (adding Beneprotein)
or 125 ml high protein liquid (e.g., Boost High Protein) or a popsicle
Other Snack Suggestions
125 ml (½ cup) pureed fruit, or skim milk dessert, or yogurt
2 soda/melba crackers and 15 ml nut butter (peanut, almond, etc.) or hummus High protein gelatine
Diet progression - Stage 4
Day 16 to Day 30 (weeks 3 and 4): Soft-minced Texture Diet
This diet is comprised of foods that are easy to digest which can be easily cut with a fork, without needing a knife.
Foods such as untoasted bread, pasta, rice, whole red meats can cause problems; avoid them. Wait two weeks after stage #5 before integrating small quantities of these foods.
Fatty foods such as those that are fried, breaded, or include greasy sauces can cause discomfort and are not recommended if you want your weight loss process to be suc- cessful.If ingesting solid foods causes nausea or vomiting, you need to resume the semiliquid diet.
omelette or boiled egg;cottage cheese, ricotta or soft cheeses that are less than 20% M.F.eggs garnished with plain yogurt and light mayonnaise;lentils or other legumes;canned fruit or fruit compote;poached or grilled fish;minced chicken, with light sauce;semi-firm or firm tofu;lean or extra-lean ground meat.If you have real signs of hunger between meals, choose protein-enriched snacks such as milk pudding, yogurt, a hard-boiled egg, skim milk, skim milk cheese.Consume two portions and skim or partly skimmed milk products a day.Limit your intake of added fats to 15-30 ml (three to six teaspoons) a day, preferably healthful, cold-pressed vegetable oils.
Diet progression - Stage 4
Duration: approximately 2 weeks, from to
125 ml (½ cup) cold cereal, softened in milk or hot
Corn Flakes,Special K,Rice Krispies,Oatmeal,Cream of wheat,Baby cereals
125 ml (½ cup) 2%, 1% or skim milk
1 piece of white toast without the crust, with non-hydrogenated soft margarine
30 g (1 ounce) light cheese or lean creton or 15 ml (1 tablespoon) smooth peanut butter (or other nut butter) or 1 egg.
Lunch and Dinner
60 g (¼ cup) meat, pureed chicken or poached fish in a light sauce (béchamel, tomato
sauce), silk tofu or omelette (2 eggs)
90-125 ml (¼-½ cup) mashed/chopped vegetables 90-125 ml (¼-½ cup) pureed potato
Wait 60 minutes after the meal for liquids
125 ml (½ cup) suggested fruit juice (see p. 13) or skim milk or 125 ml soup (with Beneprotein added)
or 125 ml high protein liquid (e.g. Boost High Protein)
125 ml (½ cup) pureed fruit, or skim milk dessert, or yogurt or 2 soda/melba crackers and 15 ml nut butter.Or high protein gelatine
Diet progression - Stage 5 (week 5) Normal Diet
Food cannot pass through the opening of the new stomach unless it is chopped into very small pieces. So, chew your food as much as possible and be attentive to when your body tells you that you are hungry or full.A small meal should take you at least thirty minutes to eat.
Wait two weeks before including small quantities of bread, pasta, rice and whole red meats, which can be more difficult to swallow.
Aim to consume the minimum servings from each of the Canada’s Food Guide groups every day:
2 servings of skim milk and alternatives a day;
2 servings of fruit and at least 4 servings of vegetables a day;
5 servings of whole grain products (or starches) a day (multigrain breads, whole- wheat pasta, baked potatoes, sweet potato, rice, etc.)
2 to 3 servings of meats and alternatives a day. Remove the visible fat from the meat and the skin from poultry, and choose non-fat cooking methods: in the oven, on the grill, steamed, etc.
1 serving of meat and alternatives is equal to:
2½ ounces (75 g) of meat, poultry or cooked fish
2 tablespoons (30 ml) of peanut butter
½ to 1 cup (125 to 250 ml) of legumes.
Eat 3 small meals with 2 to 3 protein snacks every day to ensure that you maintain optimal weight and to better manage your hunger and feeling full.
Focus primarily on your protein intake in the beginning and gradually leave more room for other foods on the menu so as to achieve balanced meals according to the Healthy Plate concept and Canada’s Food Guide.
Useful Information for all Bariatric Surgeries, Including Gastric Sleeve Surgery
It will be important to avoid stretching your small stomach during the first weeks, i.e. by vomiting. Vomiting may lead to gastritis, cause pain and render the surgery less effective.
It will be necessary to consult with your pharmacist to know if your medication may be crushed or if it is available in syrup form to make its consumption easier after surgery. Refrain from chewing gum; if swallowed, it may cause an obstruction.
Vitamin and Mineral Supplements
Blood testing will be necessary 6 and 12 months after your surgery, at the very least, regardless of the type of surgery. Afterwards, the frequency of these tests will be decided by your doctor and nutritionist. Complete multivitamins are recommended for all surgery types, and other vitamins and minerals will be added based on your medical and nutritional status. Nutritional supplements, in chewable or syrup form, are
recommended for at least the first month after the surgery, if possible.
Specifics for Biliopancreatic Diversion/Roux-en-Y Gastric Bypass Surgeries
Start taking your supplements 3 to 4 weeks after your surgery, when your surgeon gives you the prescription. Blood tests and nutritional supplements will be required for the rest of your life when undergoing these types of surgeries.
Complete multivitamin, a tablet / day (prenatal = higher in iron)
Calcium (citrate, preferably) 500 mg, twice daily
Vitamine D 10,000 I.U., once a week
Vitamine A 50,000 I.U., once a week (for BPD)
Ferrous sulphate 300 mg once a day (evening)
Vitamin B12 350-500 mcg once a day or 1000 mcg injx once a month
Specifics for Gastric Band Surgeries
If you can’t easily reach satiety, adjustments to the band cannot be made before four to six weeks after your surgery. Time may vary from patient to another. Adjustments are performed by inserting a very small quantitiy of saline solution in the band. After each adjustment, you will be asked to drink small quantities of liquids to test your tolerance to liquids before moving on to solid foods. Make sure the band is not too tight, allowing you to eat a variety of solid foods included in a balanced and healthy diet.
Successful Nutrition Strategies
Your surgery can improve your health and reduce obesity for the long term if you change your food habits and lifestyle which includes exercise.
Ensure that you have follow-up appointments with your nutritionist after your surgery. Your nutritionist will help you maximize the results of the surgery over the short and long term.
Eat 3 small meals and 2 to 3 protein snacks / day
Take liquids (including soup) between meals, i.e., 30 minutes before and 60 to 90 minutes after meals. Be sure to avoid mixing liquids and solids.
Eat slowly (approximately 30 to 40 minutes per meal) in a relaxed setting, and chew
your foods at least 15 to 20 times per mouthful.
Ensure that you spend a longer time chewing sticky, dry and stringy foods: rice, fresh bread, corn, nuts, seeds, fruits and vegetables with peels, lettuce, tough meats, etc., to prevent blockages and digestive discomfort. Savour your foods and avoid having your attention distracted by reading or watching television during meals.Drink water a little at a time, but frequently. Ensure that you drink 1.5 to 2 litres of liquids a day between meals and limit fruit juice, alcohol and sweetened beverages.Avoid diet and regular carbonated beverages. These can contribute to enlarging your small stomach.To avoid filling your small stomach unnecessarily with air, limit chewing gum and drinking with a straw.Limit foods that are processed, high in fat and/or sugar and salt: pastries, chips, honey, maple syrup, candy bars, jams, deli foods, etc. Foods with a high sugar concentration can increase the risks of bloating and diarrhea.Listen to your signs of hunger and being full instead of completely ignoring them.Do not undertake any other weight reduction program without discussing it with your nutritionist. Several weight reduction products and diets that result in major weight loss can cause unwanted side effects such as loss of muscle mass, reduced basal metabolism (energy expended at a resting state), heart arrhythmia, gallstones, nutritional deficiencies, etc.Remember that food is meant to be tasted, so take the time to eat and enjoy your foods. The more you enjoy each bite, the fewer bites you’ll need to take!Be realistic in your weight loss objective. Too-rapid weight loss, more than 0.5 to 1 kg per week, can threaten your health. However, it is possible for you to lose a bit more than 1 kg per week during the first weeks following surgery.Get moving! Any increase in physical activity, however small it may be (10 minutes at a time), is helpful. Get a pedometer and aim for 6,000 to 10,000 steps per day in the long run.Above all, aim to improve your health and well-being.
(In French only)
Johnson & Johnson «REALIZE mySUCCESS®» Post-op Motivation Program:
Documentary short prepared by Enzyme Communication: «Weight Matters»:
5 / 30 Health Challenge: www.defisante530equilibre.ca/index.php/ds_eng/content/ view/full/480