PRE-SURGERY DIET OPTIONS DURATION:

___ Weeks before surgery

TYPE:

High protein, low fat and low carbohydrate

PURPOSE:

1) To reduce fat in the liver that will decrease risks of liver damage during surgery. 2) To reduce weight which will decrease overall surgical risks.

CHOICES:

Choose a combination liquid and food diet OR a full liquid diet.

NOTE:

Drink only liquids the day before surgery.

I. COMBINATION LIQUID AND FOOD DIET: 1) Multi-vitamin with minerals and calcium should be taken daily. 2) 3 high protein and low carbohydrate, sugar and fat shakes per day. (See choices on page 2) 3) Dinner meal

Do not use any butter, margarine, oil, mayonnaise or other fat on your food during the pre-surgery diet. Herbs and spices are fine to use on your food as is cooking spray.

a) 4-6 ounces of very lean/lean protein. (See choices on page 3) b) 2 servings of bread/starch. (See choices on page 3) c) 2 one-half cup servings of vegetables (excludes corn, lima beans, peas, plantains, potatoes, yams, winter squash and yucca). No butter, margarine, oil or other fat. d) 2-cups salad greens with, if desired, cucumbers and tomatoes. Use fat free salad dressing or vinegar. 4) Evening snack a) 1-cup fat free/low fat yogurt, OR, if you do not have diabetes, b) 1 piece of fruit, 1 cup of berries or 17 grapes. 5) Drink six to eight 8-ounce cups of water per day. Caffeinated coffee/tea is allowed with artificial sweetener and fat free/skim milk. However, do not use more than 8 ounces of fat free/skim milk in your coffee per day. 6) You may have unlimited amount of these raw, non-starchy vegetables throughout the day: cucumbers, carrots, bell peppers, celery and lettuce but with no added fats, dips or marinades. You can use fat free dressing, vinegar or freshly squeezed lemon or lime. 1

HIGH PROTEIN SHAKE(a) CHOICES Purchase at GNC, The Vitamin Shoppe or in a health food store unless noted otherwise. Pre mixed drinks 1) Worldwide Pure Protein Shake® 2) Designer Whey Protein Blitz™ (LF) 3) Isopure Zero Carb® (LF) 4) ZOIC Nutrition Drink(e) 5) Cytomax® Protein Ready-To-Drink (LF) 6) Premier Protein(d) 7) GNC Total Lean™ Lean Shake™ (LF) 8) Designer Whey Protein Shake® (LF) 9) EAS AdvantEDGE® (kosher)

Powders(a) – add 1 scoop to 1 cup fat free or 1% milk OR 1 cup of fat free or light yogurt, flavored or plain 1) Baratric Advantage® High Protein Meal Replacement(b) (LF) 2) Designer Whey Protein® 3) MET-Rx Meal Replacement® 4) Isopure Zero Carb® (LF) 5) Jay Robb™ Whey Protein (made with Stevia) 6) Nectar Protein 7) Unjury(e) (LF) 8) Chike!(f) 9) Bariatric Fusion Meal Replacement(g) (LF) 10) Naturemax® (kosher)(c) (LF) 11) Shaklee Energizing Soy Protein® (kosher)(c)(LF) 12) SPIRU-TEIN® (kosher) (LF) 13) Integrated Supplements 100% Natural CFM Whey Protein Isolate (kosher)(c) (LF) 14) Nutri-Supreme Research Whey Protein

(kosher)(c)

15) Herbalife Formula 1 Instant Healthy MealNutritional Shake Mix (kosher)(c) (LF) (LF) = Lactose Free (a) Protein supplements should have 8g or less of sugar and at least 15g of protein.

(b) Purchase at: www.BariatricAdvantage.com. (c) Purchase online at www.MaxiHealth.com, www.shaklee.com, www.integratedsupplements.com, www.nutrisupreme.com or www.herbalife.com. (d) Purchase in Costco, BJ’s and Sam’s Club. (e) Purchase at www.Unjury.com. (f) Purchase at www.ChikeNutrition.com. (g) Purchase at www.BariatricFusion.com.

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VERY LEAN/LEAN PROTEIN CHOICES (4 to 6 ounces) Chicken or turkey breast, without skin Fin fish and shellfish Tuna canned in water 91%-99% lean ground beef or ground sirloin

Sirloin, round or flank steaks, filet mignon Roast beef Ham Pork tenderloin

BREAD/STARCH CHOICES (CHOOSE 2 OR DOUBLE ONE) 1 slice of bread (1oz) ½ hamburger roll (1oz) ¼ bagel (1oz) 2 bread sticks (1oz) ½ pita (1oz) 1 corn tortilla (1oz) ⅓ cup of cooked rice, pasta

⅓ cup of cooked barley, couscous, kasha ½ cup of cooked bulgur wheat ½ cup of corn, lima beans, green peas, plantains, potatoes, yams, winter squash or yucca 1 corn on the cob 1 baked potato (3oz) 6 saltine crackers ½ cup legumes (beans), lentils and split peas SAMPLE DAY

Breakfast 1 high protein shake Lunch 1 high protein shake Afternoon Snack 1 high protein shake

Dinner 4-6 ounces of flounder fillet 1 cup of steamed sliced carrots 1 (6oz) baked yam 1 cup salad greens Evening Snack 1 cup of Axelrod Fat Free Strawberry yogurt

You can rearrange the shakes, meal and snack anyway that you want. For instance, you may want to have the dinner meal for lunch and the evening snack as a breakfast or afternoon snack. However, by the end of the day, you should have had three high protein shakes, the dinner meal and either a yogurt or some fruit as outlined on page 1. 3

II. FULL LIQUID DIET—Choose one of the products below unless another shake has been approved by your RD: A. 5 Bariatric Advantage® High Protein Meal Replacement Shakes PLUS 1 Bariatric Advantage® KetogenX™ bar per day.  This product is protein powder that you mix with 8 ounces of water.  Go to www.BariatricAdvantage.com, click on “Meal Replacements” for the powder and “Protein Bars” for the bars. You can also call 1-800-898-6888.  For a two week diet, you will need to purchase 2 bags of the protein powder and 14 bars (approximately $170). Each bag has 35 servings. Single serving packets are available for $3.25 each and Ready-To-Shake bottles (powder included, just add water) are available for $2.95 each.  The shakes come in chocolate, vanilla, strawberry, banana, iced latte and orange cream. The bars come in chocolate, peanut, apple, berry and chocolate peanut butter.  The shakes are lactose free.  Each shake has 150-160 calories, 27g of protein and 5g of fiber. Each bar has 150 calories, 11g or 12 g of protein and 6g fiber. OR B. Kosher: 5 Herbalife® Formula 1 Instant Healthy Meal – Nutritional Shake Mix® Shakes per day. Make sure that you purchase the Instant Healthy Meal and not the

regular Nutritional Shake Mix which has only 9g of protein.      

This product is protein powder that you mix with 8 ounces of water. Purchase this product at www.herbalife.com. For a two week diet, you will need to purchase 6 tubs of the protein powder.

The shakes are lactose free.

The shakes come in creamy chocolate and vanilla dream. Each shake has 200 calories, 20g of protein and no fiber. OR

C. 5 GNC Total Lean™ Lean Shakes™ (pre-mixed)  Purchase this product at GNC or www.gnc.com.  For a 2 week diet you will need to purchase 70 drinks (approximately $140).  The shakes are lactose free.  The shakes come in Swiss chocolate and vanilla bean and strawberries and cream.  Each shake has 170 calories, 25g of protein and 3g fiber.

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OR D. 5 GNC Total Lean™ Lean Shake™ 25 (powder). Make sure that you purchase the Lean Shake 25 and not the regular Lean Shake that has only 9 grams of protein.  This product is protein powder that you mix with 8-10 ounces of water.  Purchase this product at GNC or www.gnc.com.  For a two week diet, you will need to purchase 5 tubs of the protein powder (approximately $215).  The shakes come in rich chocolate, chocolate peanut butter, banana, cookies & cream, pumpkin spice, mixed berry, peppermint mocha and French vanilla.  Each shake has 200 calories, 25g of protein and 8g of fiber. OR E. 5 Bariatric Fusion Meal Replacement Shakes.  This product is protein powder that you mix with 8 ounces of fat free milk or water.  Purchase at www.BariatricFusion.com or call 1-866-259-0602.  The powder is lactose free.  For a two week diet you will need to purchase 3 tubs of powder (approximately $114; shipping is free for orders over $75). Single serving packets are available for $2.50 each or you can purchase a variety pack of all the individual flavors for $20.  The shakes come in Chocolate Mouse, French Vanilla, Strawberry Shortcake, Cinnamon Bun, Mint Chocolate Ice Cream, Orange Cream and Cappuccino.  One scoop of powder provides 138 calories, 27g of protein and 5g of fiber. Add an additional 8g of protein if the powder is mixed with 8 ounces of fat free milk. OR F. 5 Premier Nutrition Protein – High Protein Shakes (pre-mixed)  Purchase in Costco, BJ’s, Sam’s Club or at Amazon.com.  For a 2 week diet you will need to purchase 70 drinks (approximately $146).  The shakes come in vanilla, chocolate and strawberry.  Each shake has 160 calories, 30g of protein and 3g fiber.

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NOTES:  To increase your fiber intake and prevent constipation, take a daily fiber supplement.  Don’t forget to take a separate multi-vitamin with minerals and calcium with vitamin D while on the Shakes.  Drink six to eight 8-ounce cups of water per day. Caffeinated coffee/tea is allowed with artificial sweetener and fat free/skim milk. However, do not use more than 8 ounces of fat free/skim milk in your coffee per day.  You may have unlimited amount of these raw, non-starchy vegetables throughout the day: cucumbers, carrots, bell peppers, celery and lettuce but with no added fats dips or marinades. You can use fat free dressing, vinegar or freshly squeezed lemon or lime.

N. Restuccia, MS, RD, CDN M. Urban-Skuro, MS, RD, CDN 7/09, 9/09, 9/09, 10/09, 12/09, 1/10, 2/10, 4/10, 10/10, 1/11, 6/11, 8/11, 12/11, 5/12, 7/12, 12/12, 3/13, 9/17/13

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