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Preparing For Surgery

Preparing For Surgery

1 month before surgery

  • Stop smoking if you haven’t already!
  • Purchase Pre-Op diet kit
  • Stop Taking:
    – Birth control Pills, hormones
    – Steroids and immunosuppression medications
  •  Fasting Bloodwork
    – All facilities require updated blood work within 30 days of your surgery date. Please go as soon as possible to have your labs drawn– as results can take
    up to 2 weeks.

2 weeks before surgery

  • Start a Pre-Op modified liquid diet
  • Limit caffeine intake
  • Stop carbonated beverages
  • Stop taking:
    – Appetite suppressant
    – NSAID (advil, ibuprofen, Celebrex, naprosyn, meloxicam etc.)
    – Herbal medications

1 week before surgery

  • Pick up post op medications
  • Start taking Thiamine 100 mg daily
  • Stock up on hydrating fluids, sugar free popsicles & protein shakes
  • Stop taking Aspirin.
  • Do you have your SCD? If not, call office.

2 days before surgery

  • Stop Taking:
    – ACE inhibitors (captopril, vasotec, lotensin, lisinopril etc..)
    – ARB Medications (losartan, valsartan, benicar, irbesartan etc..)

Day before Surgery

  • Do you know surgery time and arrival details for hospital?
  • No eating or drinking after midnight
  • Shower with Antibacterial soap

Day of Surgery

  • Leave all valuables at home
  • Take emend 2 hours before surgery with small sip of water
  • Bring C-PAP/BiPAP and SCD to hospital
  • Do not eat or drink anything
What Medications Should I Stop Before Surgery?

Once you begin your liquid diet your routine medications may need to be adjusted. 

**If you have diabetes, please let your physician managing your diabetes know that you will be on an 800 calorie a day liquid diet.  Re: Insulin in on an individual basis, Dr Carlton will discuss plan that is right for you.


1 month before surgery stop all:

  • Birth control medications and hormones. These medications need to be stopped because of the potential for increased bleeding and or increased risk of blood clot
  • Prednisone, steroids and immunosuppression medications

2 weeks before surgery stop all:

  • Appetite suppressants
  • Anti-inflammatory medications (Advil, Aleve, ibuprofen, Celebrex, Naprosyn, Meloxicam, etc.)
  • Herbal medications

3-5 days before surgery stop all:

  • Aspirin

2 days before surgery stop all: 

  • ACE inhibitors: (captopril (capoten), vasotec (enalapril), lotensin (benazepril) ,lisinopril (prinivil)
  • ARB medications: (losartan (cozaar), valsartan (diovan HCT), Benicar (olmesartan), irbesartan (avapro)
Pre-Op Diet

The Liver Reduction Kit is a high protein, low carbohydrate, low-calorie meal plan designed to shrink the size of the liver quickly and safely prior to bariatric surgery. The protein shakes in the liver kit are formulated specifically for bariatric surgery and we highly recommend using this kit prior to surgery. Most cases, you will start this approx. 2 week before your surgery unless Dr. Carlton.


Breakfast: Protein shake
Snack: Protein bar
Lunch: Protein shake
Snack: Protein bar
Dinner: Protein shake


*Protein shakes can be mixed with 6-8 oz. fat-free milk, unsweetened almond milk, or water.


It is very important that you drink a minimum of 64 ounces of hydrating fluids while on your pre-op diet. Hydrating fluids are sugar-free, decaffeinated, non-carbonated and less than 15 calories per 8 fluid ounces.


Examples include Crystal Light, PowerAde, Zero, Propel Zero, etc.


You may also have unlimited: sugar-free popsicles, low-sodium broth.


If you absolutely must, you can have 3 oz white fish, hardboiled egg, or plain Greek yogurt.

Post-Op Diet

Post-Op Diet

Phase 1 (weeks 1-3)


Daily Goal #1: 64 oz Hydrating Fluids


Daily Goal #2: 60 gm Protein


Sip at least 1 oz. of hydrating fluids every 15 min to ensure you are drinking enough. When able you can you can drink to the level of comfort


  • Clear Liquids: Once you are home and tolerating clear hydrating liquids for 24 hours without nausea you can advance to full liquids.
  • Full Liquids: These liquids will provide you with energy, protein and vitamins to speed up your healing process. With full liquids, you will start to get more calories in your diet.
  1. Protein Shake Requirements: 100-200 calories, 15-30 grams protein less than or equal to 10 gm of carbohydrates.
  2. Soups requirements: Strained or Blended. No lumps, bumps or pieces in the soup. Must be heart healthy – meaning low-fat and sodium. Too much sodium can increase risk of dehydration.


**Protein shakes DO count toward your total fluid during your liquid diet**


Hydrating Liquids Full Liquids
sugar-free, decaffeinated, non-carbonated and
less than 15 calories per 8 fluid ounces.
● Water
● Water enhancers (Crystal Light,
MIO, etc) – do not buy the
products that say “Energy” on
the label, as these water
enhancers have caffeine in
● Low-sodium chicken, beef, or vegetable
● Decaffeinated coffee and herbal teas
● Propel Fitness Water Zero
● PowerAde Zero
● Sugar Free popsicles
● Protein Shakes (Powder or Premade)
● Low fat pureed and strained soups
● Clear broths (beef, chicken, vegetable)
● Clear protein drinks – Isopure, premier, Gatorade zero protein


Phase 2 (Weeks 4-6)
Congratulations, you made it phase 2!


Soft Protein Diet

How and When to Eat: During this phase of your healing diet you will need to eat 4-5 times per day to reach your daily goal.
• Foods should be high-protein, low carb – anything you can cut with a fork. The meals need to be about 2-4 ounces of food or about 1⁄2 cup volume or less. Each meal should be separated by about 3-4 hours.



1 egg


Protein shake


1/2 cup cottage cheese


Protein shake


2oz flaky fish


• Never overeat or force yourself just to meet your goals. There will be days when you might not meet the goals – it is OK, listen to your body.
• You may still need to supplement with protein shakes during this time. Utilize protein shakes between meals to help you reach your daily protein goals.

Soft Foods
Protein: Flaky fish, cottage cheese, scrambled eggs, tofu, greek yogurt, cottage
tuna, turkey, salmon, low fat soups, avocado
Cooked Vegetables (1/4 cup): green beans, steamed broccoli, cauliflower,
steamed/sauteed mushrooms, steamed carrots, steamed peppers, steamed
Skinless Fruit (1/4 cup): apples, plums, apricots, peach, banana, grapes, strawberries, blueberries, raspberries, mango
Fats (1 tsp): avocado, reduced fat margarine, olive oil, hummus, peanut butter,
reduced fat salad dressing avocado, reduced fat margarine, olive oil, hummus, peanut butter, reduced fat salad dressing


After 6 weeks from surgery date: Your stomach is officially healed and it is time for you to advance your diet further to dense proteins. Remember to focus on your meal pattern to help you reach your daily protein goal and to help you feel your best! Protein first, followed by non-starchy vegetables, then fruits or starch.

Bariatric Medications

Bariatric Medications

*Be sure to pick up Medication before your surgery*

Medication Dose/Frequency Reason
Emend 40mg 1 tablet 2 hours before surgery Post op Nausea
Thiamine 100mg 1 tab daily x 1 week before
surgery and 2 weeks after
Vitamin B1 Supplement
Omeprazole 40mg 1 cap once a day for 3 months Reduce stomach acid
Ondansetron 4mg 1 tab as needed every 6 hrs Nausea
Methocarbamol 500mg 1 tab as needed every 8hrs Cramping or Spasm
Tramadol 50mg 1 tab as needed every 8 hrs Pain


Based on BMI or medical history Dr. Carlton might order:

Medication Dose / Frequency Reason
Ursodiol 300mg 1 tab – 3x day for 3
If pts have a gallbladder
Eliquis 2.5mg 1 tab daily x 30 days Help prevent blood clot
Lovenox 40mg/0.4ml subQ daily x 10 days Help prevent blood clot

**For blood thinners, would only be 1 medication and will depend on insurance.

Helpful Tips

Helpful Tips After Bariatric Surgery

• The first few days are always the hardest…You CAN do this!
• Full Liquid diet for 2-3 weeks after surgery.
• Take slow, small sips – drinking too fast or too much can cause
cramping and discomfort and possibly nausea.
• HYDRATE – very important to stat hydrated, PEDIALYTE is a great
hydrating fluid to help get you through the 1st 2 weeks.
• Be sure to WALK…WALK…WALK
• Wear your SCD as directed important to help with circulation to
prevent blood clots.
• Use your incentive spirometer helps to expand lungs and prevent
• Take all medication as prescribed.
• You can take over the counter GasX if you are experiencing gas
• If you have not had a bowel movement after 3-5 days after surgery.
You can add a daily cap of MiraLAX to your hydrating fluid until your
bowels return back to normal
• Incisions: you can wash with mold soap and water. Dry thoroughly.
Do not peel off steri-strips or glue, let it come off naturally. Do not
put any ointment or creams on incision. When glue or bandages
come off you can place a steri-strip over to help with healing
• You do not need to crush any of your medications
• Sugar free popsicles are great to get you through the first few weeks

Post-Op Follow Up Schedule

Post-Op Follow Up Schedule

We will order labs at 3, 6 and 12 months – please allow enough time for
labs to be processed. Some labs can take up to 2 weeks to process.

You will be REQUIRED to follow-up with your bariatric provider as follows:

• 2 weeks
• 6 weeks
• 3 months (review labs during appt)
• 6 months (review labs during appt)
• 9 months
• 1 year (review labs during appt)
• After 1 year: routine follow is extremely important.
– 2 year – 2 x year
– 3 year – 1 x year

If you have any issues or concerns that need immediate attention, please call
office and we will get you in to see our providers.



WATER helps the body in a variety of ways:
• Essential Nutrient for Body
• Normal body function
• Appetite suppression
• Fat metabolism
• Treating fluid retention
• Relieving constipation


• After bariatric surgery you are at an increased risk for dehydration due to the limited space in your
stomach, you will need to sip on fluids all day long.


Signs & symptoms of dehydration:
• Flushed face
• Extreme thirst
• Dark urine
• Dizziness or weakness
• Cramping in the arms and legs
• Sleepy/irritable feeling
• Headaches, dry mouth, dry tongue, thick saliva
• Weak pulse
• Cold hands and feet
• Rapid breathing
• Confusion, lethargy, and difficulty arousing

**If you are experiencing any of the symptoms, please call the office to speak to clinical staff**


Fluid Requirements: 60-64oz. Hydrating fluids per day—everyday
• Does not hurt to drink more than the recommended amount
• Some individuals may have higher fluid needs than what is recommend:
– Exposed to extreme heat
– Strenuous job (increased perspiration)
– Increase in exercise regimen
– During time of illness


Acceptable Fluid Options: Sugar-free, decaffeinated, and non-carbonated liquids
• <15 calories per 8 fluid ounces
• Some hydrating fluid options include:
• Water
• Sugar-free drink mixes (crystal light, sugar-free Kool aid, etc.) Does not include crystal light “energy”
• Decaffeinated tea/coffee
• Sobe Lifewater Zero
• Vitamin Water Zero
• PowerAde Zero
• Sugar-free popsicles
• **Pedialyte (recommend directly after surgery to help with electrolyte balance and help prevent


Fluid changes after Surgery
• No fluids during meals
• No fluids 30 minutes after meals
• Slow and Steady wins the race – sip,sip,sip ALL DAY LONG

Vitamins & Minerals

Vitamins & Minerals

• Vitamins help to maintain your body’s cells, tissues, and organs
• Consuming nutrient dense foods are a great way to obtain all of the vitamins and
minerals that your body needs. However, many times our diets lack the essential foods
needed, resulting in vitamin deficiencies.
• After bariatric surgery, your food intake is far less than before, this is why it is very
important to take all of the necessary vitamins in order to prevent deficiencies and
maintain a healthy diet


Bariatric specific vitamins are desired because they are more acidic vitamins and will break
down easier in your new stomach
• Multi-Vitamin (MVI)
– MVI that contains 200% of the daily value of most nutrient
• Vitamin B12 (Will be in your MVI)
– 500mcg/day OR 2,500mcg weekly
• Calcium Citrate
– Calcium Citrate w/Vitamin D: 1200-1800mg per day
• Vitamin D
– 2,000-5,000IU daily (1,000-2,000 IU will come from your MVI)
• Iron (Will be in your MVI)
– Bypass and DS: 45 mg per day + MVI
– Sleeve: 100% DV of your MVI
– Additional Iron may be prescribed depending on your lab values
• Vitamin B1 (Thiamine)
– 100 mg per day for 2 week after surgery

** We will check blood work at 3 months, 6 months, and 12 months after your surgery to check vitamin

levels and determine if any supplement changes are needed.

Optional/Possible Needs:
• Fish oil
• Biotin


• Must space vitamins throughout the day to maximize absorption
• Your body will only absorb 500-600mg calcium at a time
• Space out at least 2 hours to maximize absorption

• Iron and calcium can compete for the same absorption site in your small intestine must
take these supplements separately
• Tea and coffee decrease iron absorption. Avoid taking your iron with these beverages


Before Breakfast (8am)
  • Multivitamin
  • B12
  • Fish Oil
  • Thiamine
Mid-Morning (10am)
  • 500mg Calcium Citrate w/ Vit D
Lunch (12pm)
Mid-Afternoon (2pm)
  • 500mg Calcium Citrate w/ Vit D
  • 30mg Iron
Evening (8pm)
  • 500mg Calcium Citrate w/ Vit D


Vitamin deficiencies can be related to a multitude of factors, including:
• Dietary intake
• Previous nutrient intake/deficiencies
• Adherence to recommended post-operative
• supplementation
• Degree of malabsorption associated with bariatric surgery procedure


**REMEMBER: Preventing vitamin deficiencies are easier than treating them
Helpful tips to help you stay on track with your vitamin regimen
• Set a timer on your phone
• Carry a small container with daytime vitamins if you are not going to be home
• Keep your vitamins on a nightstand or by your toothbrush


Exercise After Bariatric Surgery

• Exercise is the key to continued success after surgery
• MUST begin walking same day as surgery
• No lifting anything more than 25 lb. for the first 2 weeks
• Avoid sexual intercourse for 2 weeks
• Avoid heavy housework (vacuuming, mopping, lifting heavy laundry baskets for 3 weeks
• No strenuous exercise for at least 4 weeks (Bicycling, elliptical, aerobics, lifting weights,
running, Pilates, etc.)
• After 6 weeks you can resume all regular activity
• Stairs are ok to use, as tolerated



• Start slowly and build up gradually over time
– 2 times per week for 15-20 minutes of walking
– 3 times for 15-20 minutes of walking
– 3 times for 30 minutes
• Vary your workouts: The best type of exercise is one that you will enjoy
• Choose exercise classes that are designed for beginners
• Develop specific and realistic exercise goals
• Try to have a backup workout plan
– Normal routine: walk outside
– Bad weather: use a walking DVD in doors
• Keep a pair of walking shoes & exercise clothes in your car



• Take the stairs instead of the elevator
• Park at the far end of the parking lot and walk to the office or store
• Yard work: Mow the lawn and rake leaves
• Get up from your desk to deliver a message instead of using e-mail
• Walk to run your errands instead of driving


• Walking, jogging, running
• Elliptical / stairmaster
• Swimming
• Housework (sweeping/moping)
• Yard work (push mowing)
• Dancing
• Bicycling / Arm bike
• Pickle ball
• Water aerobics
• Yoga
• Hiking
• Work out DVDs
• Lifting weights/ using resistance bands


• Purchase shoes that fit your feet appropriately
• Runners buy 1 size bigger than they normally wear to allow for wiggle room
• Wear comfortable clothing to prevent chafing
• Confidence
• Use a system to track weight, what you eat, and exercise
– Apple Watch
– MyFitness Pal
– Pedometer
– Fit Bit
– Notebook (with food journal, weights, and exercise)
• Find things you can do that will make exercise more fun
• Listening to music
• Watching a movie On iPad/phone

Bariatric Meal Ideas

Bariatric Friendly Meal Ideas

Breakfast Options:
• Protein bar: Pure Protein, Supreme Protein, Quest Protein (limit one per day)
• Protein shake: Bari-Essential, Premier Protein, EAS Carb Control
• Eggs with lean protein (Canadian bacon, turkey sausage, turkey bacon, lean ham, low-fat
• Omelet (egg substitute, lean turkey, bell pepper, onion, and 2 % milk cheddar cheese)
• Egg “muffins” (mix egg/egg substitute in a muffin tin with meat/veggies; bake on 375° for 20-30
• minutes)
• Healthy frittata
• Hard-boiled egg & 1 low-fat cheese stick
• Plain Greek yogurt (add cinnamon & Splenda) or Dannon Light and Fit (flavored) Greek yogurt
• Low-fat or fat-free cottage cheese with ¼ cup fruit
• Low-carb breakfast burrito (low-carb tortilla, egg, lean meat, low-fat cheese, salsa)
• Deli meat and cheese roll-up (roast beef with 2% milk mozzarella, chicken with 2% milk pepper
• cheese)
• Eating Out: insides of breakfast burrito, insides of egg McMuffin
• Protein pancake (1 egg, 1/3C low-fat cottage cheese, 1/3C oats; blend all together and cook on


Protein based “Power-Ups” (aim for 100-200 calories per snack)
• Low-fat cheese sticks or Babybel cheese wedges
• Low-sodium beef jerky
• Deli meat and cheese roll-ups (2 slices of lean turkey/ham rolled around 1 light cheese stick)
• Deli meat (2-3 thin slices)
• Single serving tuna pouch (flavored varieties: lemon pepper, sweet & spicy, Ranch, Hickory
• Hardboiled egg (1-2)
• Deviled egg (made with low-fat condiment/Greek yogurt)
• Protein shakes (Bari-Essential, Premier Protein, and EAS Carb Control)
• Protein bar (Quest protein, Supreme Protein, PureProtein- no more than 1 protein bar per day)
• Low-fat cottage cheese (ok to have with fruit, if desired)
• Edamame
• Greek yogurt (Dannon Light and Fit flavored or plain with sugar-free syrup or cinnamon &
• 1 cup low sodium broth plus 1 scoop Bari-Clear protein powder
• 2-3oz. lean meat (chicken breast, turkey tenderloin, etc.)


Easy Lunch Options:
• Deli meat and cheese roll-up: add hummus, avocado, or mustard to enhance flavor; roll-up in a
lettuce leaf to add texture
• Chicken salad served on a lettuce leaf (canned chicken, light mayo, black pepper)
• Buffalo chicken salad served with celery sticks and 1 Tbsp. light bleu cheese dressing (canned
• 1-2 Tbsp. Mrs. Dash ranch seasoning packet, 1 Tbsp. buffalo sauce, 2% milk mozzarella cheese)
• Burrito bowl (pre-cooked chicken breast strips, black beans, Rotel, & ½ 100 calorie packet wholly
• guacamole)
• Chili (1lb. lean ground turkey, low-sodium chili seasoning, Rotel, 1 can pinto beans) with 2% milk
• Open-face Chicken burgers served with carrot sticks/celery and light ranch dressing

Bariatric Food List

Bari - Food List

Food Group Food to include in your Diet Foods NOT to include in your diet
Aim for <3g fat per serving
(7g protein = 1 oz.)
All poultry without skin, even dark meat (chicken breast, chicken
tenderloins, lean ground chicken/turkey, turkey products–pepperonis,
sausage, turkey hot-dogs), pork (lean chop, pork tenderloin, Canadian
bacon, lean deli-ham), lamb (roast, chop, leg), veal (lean chop, roast),
beef (93% lean or > ground beef, sirloin steak, flank steak, skirt steak,
beef tenderloin, all seafood (tilapia, salmon, Mahi Mahi, etc.), gamemeat, egg whites or egg substitute, fat free hot dogs, fat free/low-
fat/reduced-fat cheese, beans, edamame, lentils, tempeh, tofu, seitan
Fried or breaded meats, full-fat beef (80/20 ground
hamburger meat, ribeye, prime rib), full-fat pork
products (ribs, bacon, sausage), hot dogs, salami,
pastrami, bologna. Whole eggs should be eaten
less than 3 times per week. Skin and breading
should be removed from meats before consuming.
Aim for <3-5g of fat per 1 oz.
Low-fat/reduced-fat/fat-free: cheeses, milk, cottage cheese, ricotta,
mozzarella, and other cheeses low in fat, plain Greek yogurt or Dannon
Light & Fit Greek yogurt (lowest carb content for flavored)
Whole milk, 2% milk, high-sugar yogurts, full-fat
cheesesCorns, peas, potatoes, winter squashes (acorn &
butternut squash).
Cooked= 1⁄2 cup
Fresh/Raw serving = 1 cup
Artichoke, artichoke hearts, asparagus, beans, broccoli, Brussels sprouts,
cabbage, carrots, cauliflower, celery, cucumber, eggplant, green
onions/scallions, greens (collard, kale, mustard or turnip), leek,
mushrooms, olives, okra, onions, peppers (any variety), radishes, salad
greens, sauerkraut, spinach, snow peas, summer squash, tomatoes,
turnips, water chestnuts, watercress, zucchini
Always eat with protein to decrease
spike in blood sugar
Apples, peaches, pears, pitted prunes, grapefruit, cherries, plums,
apricots, berries, banana, raspberries, strawberries, grapes, blueberries,
Canned fruit in heavy syrups, fruit juice, and dried
1 tsp oil, 6 nuts, 1/8th avocado
1 tbsp. reg. dressing, 2 tbsp. reduced
fat dressing
Unsalted nuts, nut butters (peanut, almond, etc.), avocado, vegetable
oils, canola oil, olive oil, coconut oil, olive/canola oil based salad
dressings, light or fat-free salad dressing, hummus
Full fat mayonnaise or salad dressing, butter, hard
margarine, shortening, lard, cream (cream cheese),
trail mix
1 slice of bread, 1 oz crackers, 1/2
cup cooked grain or cereal, 1/3 cup
rice or pasta
whole grain/low calorie bread, quinoa, oatmeal, whole grain, whole
grain pasta and noodles, brown/wild rice, whole wheat pita or tortillas,
low carbohydrate tortillas, high fiber English muffins
cereals containing sugar >5g/serving, cream of
wheat, granola, grits, “enriched” grain product,
bagels, pancakes, waffles, granola bars, cakes,
cookies, gnocchi, hamburger buns, muffins, pasta,
instant noodles, pizza, white or instant rice, regular
bread or tortillas, white, crackers popcorns, chips