Nutrition Instructions

Prior to surgery

At Ciba, our patients are required to follow a diet before having weight loss surgery. The diet is beneficial for balancing hormones and shrinking enlarged fatty liver. A pre-op diet is also helpful for one’s mental, emotional and physical well being both before and after surgery.

While there may be apprehension about the word “diet” patient’s with a BMI between 30 and 50 are asked to begin acquiring healthy eating habits before their surgery date.

INDEX

I. Losing weight
II. Duration of diet pre-surgery per BMI.
III. Pre surgery diet
IV. Recommended portion sizes
V. Meal Plan (Sample)
VI. Pre-surgery dietary instructions

I. LOSING WEIGHT

For patients with BMI over 50, our surgeons may require that specific dietary guidelines are met before surgery.

(SPECIAL NOTE FOR PATIENTS WITH DIABETES.)

Patients will need to adjust their insulin or medication while following the pre-op diet. It is advised to consult with a diabetes specialist /nurse/nurse practitioner/general practitioner before embarking on the diet.

II. DURATION OF DIET PRE-SURGERY PER BMI

BMI 29 to 32 – 1 week
BMI 33 to 39 – 2 to 3 weeks
BMI 40 to 50 – 4 to 8 weeks
BMI 51 to 60 – 8 to 12 weeks

III. PRE SURGERY DIET

3 main meals per day (curtailed size, pictures below show how to easily measure your meals using thumb rules)

2 or 3 small snacks (depending on when you go to sleep, you may add a third snack in the evening if you go to bed late, otherwise limit yourself to 2 small snacks a day)

Important: Protein should be included in every meal or snack (it helps in feeling fuller longer and does not cause insulin levels to spike).

IV. RECOMMENDED PORTION SIZES

Use the rule of palm to measure food portions easily without any scales, cups, grams, ounces, etc. No need to count calories either, simply follow this rule.

The size of one’s palm determines a protein portion.

The fist determines a veggie portions.

A cupped hand determines carb/fruit portions.

A thumb determines fat (nuts/seeds/cheese) portions.

V. MEAL PLAN (SAMPLE)

Breakfast
Lunch
Snack
Dinner
Snack (if necessary)
Option 1: Omelet (1 whole egg + 1 egg white, handful of spinach, table spoon of chopped onions, olive oil, salt and pepper in moderation)

Mixed greens salad (olive oil, salt, pepper, lemon juice for dressing), grilled chicken breast (1/2 of breast or equal to palm size)
10-15 almonds, ½ large apple (or 1 small apple)
Sautéed broccoli (use onions and garlic, lemon juice, salt and pepper, other spices to add flavor), fried/baked/grilled tilapia (1/2 filet or portion equal to palm size)
A slice of cheese (finger size portion) with 1 mandarin
Scrambled eggs (1 whole egg + 1 egg white, any fresh mushrooms 4-6 pieces, tablespoon of chopped onions, olive oil, salt and pepper in moderation)
Tomato and cucumber salad with shrimps, chickpeas or green peas
Two small pieces of cheese, any fruit/fresh berries (1 handful)
Grilled beef steak (choose lean meat, palm size portion, no heavy sauce), a handful of drilled asparagus
Two table spoons of hummus with 1 celery stick and 4-5 baby carrots
Small Greek yogurt (sugar-free) with 1 handful of fresh blueberries
Lettuce wrap with two thin slices of turkey breast

VI. PRE-SURGERY DIETARY INSTRUCTIONS

1 month before surgery

In addition to the prescribed pre-surgery diet, patients should consult with their physicians for a suitable exercise routine. Patients with cardio-vascular or joint diseases are not required to exercise and should consult with their physicians for an adapted physical routine..

14 days before surgery

All patients will be asked to begin taking 20 mg twice a day of Omeprazole (antacid medication), with the last pill to be taken the evening before surgery. This medication aids to decrease stomach acidity, acid reflux, nausea, inflammation, and swelling caused by the procedure. Patients will continue taking antacid medication after surgery for at least two months or until acid reflux/heartburn is gone.

 

7 days before surgery

Patients will consult with their Ciba surgeon about any medications taken regularly.

 

3 days before surgery

Patients begin a full liquid diet the last 3 days before surgery (not including the day of surgery, if surgery is on Monday, the 3 days before include Fri, Sat, Sun) it is required that patients follow a full-liquid diet. This “liquid stage” can be increased to 5, 7 or more days by the surgeon depending on one’s BMI and duration of the solid food diet stage. Our surgeons will inform patients if they are required to increase the “liquid stage” during the pre-op consultation.

 

Your liquid meals can include the following options:

  • Plain Greek yogurt (or regular sugar-free yogurt),
  • Protein shakes with low (3 g) or “0” carbs and low or “0” fat (good protein shake should include no more than 3 g of sugar and no less than 20 g of protein); limit protein shakes to 3 or 4 per day as they are considered meal substitutes;
  • Almond milk (regular or low-fat cow milk is not recommended due to high sugar levels – lactose);
  • Broth (chicken/beef/fish/vegetable broth, or liquid part of any other type of soup), feel free to add a scoop of unflavored protein powder to your broth in order to feel full;
  • Egg-drop soup (strained);
    Carrot, zucchini or squash cream soups (well-blended and strained, so there are no solid pieces, add enough water to make it thin, NO cream to be added, a little bit of milk for better taste is acceptable); you may add unflavored protein powder;
  • Sugar-free pudding/Jell-O/popsicles;
  • Fruit-infused water, especially with electrolytes, and plenty of water or herbal/fruit tea without sugar, coconut water and other sugar-free fluids are recommended;
  • Green juices (kale, spinach, celery, etc.) are allowed, fruit juices are not allowed as they contain too much fructose (another form of sugar);
  • The purpose of the liquid diet stage is to cleanse the stomach pouch and bowel from solids, and to reduce the amount of stomach acid produced, thus decreasing the chances of having heart burn after surgery. This is also important as it will help to decrease stomach pouch swelling, post surgery, and will also shrink the liver.

1 Day before surgery. Pre-op tests stage.

Usually, pre-op tests are done on the day of arrival (the day before surgery). Patients may drink liquids such as water, apple juice, Gatorade, sugar-free popsicles or Jell-O up to 3 hours before arrival into San Diego. After arrival into San Diego, it is essential to drink water only until blood has been drawn. After, one may resume drinking liquids.

The big day. Surgery

No liquids can be consumed after 10 pm the night before surgery. It is very important that ample fluids are consumed during the 3-day liquid diet to maintain hydration on the day of surgery.

Congratulations for embarking on a courageous journey to live a healthier and more vibrant lifestyle. At Ciba, we will be with you every step of the way.

Congratulations for embarking on a courageous journey to live a healthier and more vibrant lifestyle. At Ciba, we will be with you every step of the way.