pureed diet

perfect. all right so i know i mentioned ifyou guys had any questions, feel free to ask quick ones in class, but if you have a verypersonal question or a more detailed question, please make sure to email me or call me upand then i can get to you and we can talk in more detail. all right.excuse me? yes.why are they taking a picture? we're filming this class for future webinarsand future filming for our website. yah. yah. okay. all right, it's all for our websiteand for future webinars so that patients have access to this a year down the road or twoyears down the road, or at anytime they need it on the website. all right, so where wasi? questions. questions. we got that. the

next thing i want to let you guys know isthat we're going to be starting in your binders on a tab that says "first taste". so that'swhere we're starting. oh, i'll grab that. excuse me. all right. thank you. all right,so we're starting there. now folks, everything on the presentation is indeed in your binder.now if you have a pen, keep it handy, because these are your binders moving forward. makenotes, scribble in it, do whatever you need to do because these are your binders, movingforward for the rest of your life. there are some things on here that i've updated thatis on the presentation, but is not in that version of the binder. so, here we go. blossombites, this is your first taste after surgery. i'll be going a month after surgery. all rightfolks, so after surgery there's three things

we need you to focus on. the first one ismaking sure that you're getting plenty of protein and those will be coming from yourprotein shakes. who all is doing the preop two shake and a meal lean and green? perfect.so you're very well versed in those protein drinks right? okay. so you're going to keepdoing those after surgery. that's going to give you the most protein that you can absorbafter surgery. now we're going to talk about the slip and slide funnel diet list and thatis coming up in the next couple of slides, but the goal is to get 40-60 grams of wheyprotein a day, every day. the second thing we really need you to focus on is to makesure you're drinking plenty of fluids and we're going to talk about how much and whatkinds in the next couple of slides. and the

third thing we need you to focus on is toget up and walk around every hour that you're awake. now, of course if you go to your hotelroom, or you go home after surgery, this just means walking around the house or walkingup and down the hallway, maybe once or twice, just every hour. this will help make surethat your circulation is working the way we need it to. alright, so after surgery, weneed to treat your new stomach, or your new pouch like a brand new baby stomach in training.it's going to be a newborn stomach. protein is the most important nutrient you need aftersurgery. not only does it help you heal, it does help repair tissues and it really helpsyou stay full longer and it helps stabilize your blood sugars. all right? so you're goingto consume 40-60 grams of whey protein a day

and, of course, after about two weeks thatprotein will increase to about 60-80 grams a day. i know 80 is a lot, but it's goingto give you enough, particularly my guys, depending on your activity level. you cango higher than 80 grams if you start exercising. so we can talk about that. after surgery weneed you to consume at least six cups or 48 ounces of fluid a day. now that is only toprevent dehydration. water is always best, but if you're tired of water, again try the80/20 rule. 80 percent could be water and 20 percent could be sugar-free fluids. we'regoing to talk about those in a minute. so try crystal light pure. for those of you thatare familiar with crystal light, i always recommend crystal light pure. they've comeout with that, it's been out for about a year

now. they utilize natural sweeteners, naturalflavors and natural colors and they are less irritating to the stomach lining. also, sobelifewater, zero calores. a lot of patients like that after surgery. that is also sweetenedwith natural sweeteners called stevia and they don't put in any artificial colors orflavors in all of that too. also, green tea, herbal teas, these tend to work really welltoo. all right? great. all right, so here we go with the funnel diet list. all right,so the slip and slide/funnel diet list is for the first 2 weeks after surgery. you canpick and choose out of this list for the rest of your life if you like the foods, all right?so the reason why is because we want to prevent solid and heavily textured foods from puttingtoo much strain and pressure on your new stomach

and possibly rupturing those sutures. so examplesof the funnel diet foods would be no sugar-added applesauce or low-fat greek yogurt. itemsthat are not a good example of the funnel diet would be rice, oatmeal, and mashed potatoes.they just stick and clump. so here is the list and you'll notice in your binders, ifyou're following, that some of the list is not in there and you're page says blossombites examples, it should say examples of funnel/slip and slide foods. yes, it is righthere my dear, this next page. yah, right there. yes, so feel free to add or shoot a pictureof this as well. obviously your whey protein shakes, low sodium broth works really well.low-fat or fat-free greek yogurt can work, low-fat or fat-free cottage cheese withoutfruit, a soft scrambled egg, believe it or

not, low sodium v8 juice, maybe some tomatosoup, no sugar-added applesauce. now here we go, sugar-free jello and sugar-free popsicles,please keep in mind that these are artificially flavored, artificially colored and not reallyfood, but sometimes after surgery your throat hurts, it gets dry and scratchy. these feelgood going down, so i left those on there. of course water, almond milk, rice milk, coconutmilk, and water. these are approved drinks as well and approved to mix your protein powderwith to make your shakes. notice there is no dairy milk or soy milk, okay? so no cowmilk and no soy milk. if you have any questions regarding soy i can certainly talk with youat the end of this or maybe at another time, but again it's very irritating to the stomachand hard to digest and can cause some allergies

etcetera and dairy milk same thing. you couldhave symptoms of lactose intolerance and irritating liquid after surgery to try to break downand digest. most of our patients love almond milk. it makes your shakes really creamy,yah, it sure does. all right, so for those of you who find that they're craving thingsthat are spicy after surgery or if you really love spicy food, you can go for it after surgery,but here's the trick, because you are dealing with a brand new stomach. so what i want youto do is try a little drop of your favorite hot sauce on maybe a little bit of a softscrambled egg, or maybe a little bit of cottage cheese and you're going to take that littlebite and you're going to chew it 20-30 times and you're going to swallow and you're goingto wait and you're going to wait and you're

going to wait even long until that stomachof your gives you the green light. all right? that's the trick. what we're doing folks isreintroducing foods back to your stomach to see if it likes it, because you are goingto have a brand new stomach with new likes and dislikes. right here is where i'm goingto share with you, and this is the extreme, but it happens very frequently. many foodsafter surgery will either taste too sweet, or too salty, or too something after surgery.your taste will change. your favorite food that you crave right now, you may lose thatcraving after surgery, which could be a good thing, right? so that's the neat thing aboutsurgery, so be open to trying and introducing foods back into your life again. i had a patientsay that before her surgery she could not

stand seafood. she wouldn't cook it in herhouse, she wouldn't go to red lobster, she didn't like the smell of it and guess whatshe ate after surgery and she craved? seafood. that's all she wanted to eat. so your stomachwill do a complete 360, so try new things. i know, yah, got a brand new stomach. allright, here is your sample menu for the first two weeks after surgery. so here's, here's,this is key folks. i want you to get up and you're going to start sipping your water.i need you to keep your water by your bedside table, in your car, at your kid's soccer practice,at work. if you're retired, keep it with you on the golf cart, okay? that sipper or thatwater fluid needs to be with you at all times. it's going to help you prevent dehydrationbecause we have to sip, sip, sip, sip. when

i'm on my computer doing this, i brought thisin here, so you're just going to sip, sip, sip, all day, because right now we gulp thisdown, we get it over with, we slug it down, right? after surgery and pretty much for therest of your life, you're just going to be sipping, sip, sip, sip. it's going to takeyou about twenty to thirty minutes just to drink 8 ounces of fluid okay? so you're sippingall day. now, so it's really important to try and prevent dehydration and that's thekey. so get up in the morning and start sipping that fluid. start sipping that water. if youlike hot tea or herbal tea, that's fine too. please make sure that it's not too hot. letit cool on the counter alright? who likes coffee? alright, i knew there'd be a few,awesome. i do to. you can still have your

coffee, but keep in mind you're just goingto be able to sip a few, maybe a few ounces of it alright? so don't let it be too hoteither, okay? all right. so, and then, here's the thing i want you to continue sipping yourfluid and then when you realize its time to start making your protein drink for breakfast,i need you to stop sipping for about 15 minutes. let all that fluid pass through your new stomach.then after about 15 minutes or so i want you to sip your protein drink, which is indeedyour meal. just because it's fluid, at this point, does not mean that it is fluid. it'syour breakfast, or your lunch, or your dinner, alright? so, you're going to sit back down.it's going to take you about 20-30 minutes just to sip that, you know, 4-6 ounces ofthinned whey protein shake. all right, that's

you're breakfast. and then you can resumesipping again after 15 minutes. let that protein go all the way through your stomach, okay?about 15 minutes should do it and then resume sipping your fluid again. that's how it'sgoing to be for a while. and lunch, 4-6 ounces of thinned whey protein shake. dinner is thesame thing. so you can see how this would be pretty boring, right? so this is wherethe funnel diet food list comes in handy. so, if you're getting a little bit bored ofjust sipping on your protein drink for breakfast, lunch, and dinner, this is where this comesin really handy. you can add one or two of those things on that list, so it could bemaybe a tablespoon or just a bite of low-fat greek yogurt, maybe a tablespoon or two, orjust a bite of some low-fat cottage cheese,

or anything on that funnel diet list. thatwill help kind of break it up a little bit, alright? any questions about how to, you know,maneuver through your first two weeks? i have a questions.yes. okay, when you say that the first two weeks,right after surgery we can start doing this? you got it. yes. he asked if we can startdoing the funnel diet foods right after surgery and between your whey protein drinks and thatis yes. keep in mind, you're just going to have a few little tastes, and few little bites.well, right, right, but i mean like the next day?if you feel like it, you bet. it's on the approved list. yep.okay. thank you.

yep. keep in mind these funnel diet foodsare very, they're semi solid or they're liquid, so yes. hi, yes.is iced tea okay? absolutely. how are you going to sweeten it?are you going to do it... no. i don't like sweetener.okay, yes. iced tea is great. you bet. hi, yes. that's perfect too. yes.when you say thinned protein shake, what do you mean?well, eventually, she asked what does thinned mean? i put thinned on here for your proteinshake. i mean it needs to be thin enough you can sip it. eventually you'll be making smoothiesout of these things. you can make them as delicious and creamy as you want, but rightnow let's keep them thin so you can just sip

it down, okay?can we mix our protein with coffee? i don't recommend that because coffee candehydrate, if that's how your doing it. i do prefer almond milk, rice milk, coconutmilk, or just water, yah. if you do like coffee, you know, obviously just have it before orafter as part of your fluid, like in the morning and stuff. i love coffee too so, yah, so coffee'salways good. all right, any other questions? i always hit the wrong one, sorry. it's alwaysa little funny coming back and doing it live when i do it from my home office for monthsand months on end, so. all right folks, remember to sip fluids throughout the day and in betweenmeals. this is going to be for the rest of your life. okay, how about some troubleshooting?you probably will vomit once or twice. you'll

get, your stomach, no it's okay. your stomachis just telling you that it didn't like what you put in it the first time. most often whenyou eat too quickly you take too large of a bite, or you don't chew well enough. that'sreally all it is. and it's your new stomach or your new pouch telling you "whoa, waita minute. i didn't like that. try it again." and it will just come right back up, okay?nothings going to tear or nothing? no. you should be just fine. you should bejust fine. now these are just random vomiting if you. sometimes folks, if they take a biggulp of water. or their fluid because they forget. you know, because we've been gulpingstuff and eating quickly for most of our lives. we eat and drink really quickly in americadon't we? we just slug stuff down without

thinking about it. so your stomach is goingto be your new best tool. it will tell you how much it can handle at one time and that'sone way it will tell you, all right? okay. so just make sure you're chewing your foodwell and of course avoid sweets and carbonated drinks. these will typically cause that responseas well. so anybody having gastric bypass? oh, two, three, okay perfect. now dumpingsyndrome is a little bit more prevalent in gastric bypass, but and that's when you getinto a food that you know you shouldn't have gotten into. i'm talking the ice creams, theapple pie, the fried mozzarella sticks, the fried chicken, all right? these things, thesefats, these rancid fats and these high sugar foods are tough in your new digestive systemto break down and assimilate. so what your

body does is it will pull fluid from yourtissues and then dump it into your bowel to get rid of the offending food, so just getrid of it the fastest way it knows how, alright? so that's what that is. all right, all right,so let's talk more about dehydration, because dehydrations is the number one reason whypost-surgery bariatric patients get admitted to the e.r. okay? dehydration can sneak upon you. so please make sure you're drinking at least 6-8 servings up to 64 ounces of fluida day and i do hear from patients that it's hard to do because you have to keep sipping.so please, please, please keep sipping. now let's talk about constipation because thatis one of things that can happen as well. now usually it's the pain medication anesthesiathat will cause some constipation right after

surgery. typically if it kind of keeps upfor three or four days after your surgery, we can go a number of routes. obviously anythingover the counter will be fine, like colace or, i think there's benefiber, metamucil,you know, over the counter fiber supplements. these will work really well. some other thingsthat work very well, of course, would be ground flaxseeds, or flaxseed meal, for those ofyou who are feeling familiar with flaxseeds and their benefits. it's like natural anddelicious metamucil. you can add that to your protein powder in your shakes, yah, you canpretty much add it to your greek yogurt, it will make it really creamy and nutty flavored.it's really delicious. we're going to talk about probiotics in the supplement segmentand magnesium, magnesium citrate is another

product, or another mineral that will reallyhelp with constipation. yes hi. with that flaxseed that you were saying youcan add it to the, do you have to worry about that getting caught anywhere?yes, good question. she was wondering about the flaxseeds getting caught. please makesure that they are ground. you can buy flaxseed meal already ground up, but they should bethe consistency of sawdust. or, if you buy them whole, they even have them at winco inthe bulk section now. take those guys home, grind them up in a coffee grinder or yourblender. they should be the consistency of sawdust. okay? keep them in the fridge too.keep them in the fridge. what about the gel, the pill?oh, the flaxseed oil? well it's going to be

hard to swallow the big gel caps. i know thoseare big, yah. so if you feel like it, you can poke a hole in that gel cap and squirtit in to your protein drink. yah, yah, you bet, good question. all right, so, some moretroubleshooting things. you can stretch your new baby stomach, but you have to try reallyhard. your stomach will give you your own specific unique signal of fullness. your signalof fullness will be much different than anybody else who has had the surgery. if you've hadfamily members or co-workers that have had a bariatric procedure and they'll tell you"oh i know i'm full when i get the hiccups." right? i can guarantee that's not going tobe your full feeling, okay? so be very aware that your full feeling is there. be awareof it every time you eat and don't try to

eat past it. either you'll vomit it up, oryou could stretch your stomach. okay? all right. so we're going to talk quickly aboutreasons why patients gain weight after the surgery or why they stop losing weight. usuallyits anywhere from a couple of months to a year after surgery. the biggest culprit isthose darn starchy carbohydrates. they sneak back in to your life again. they got everybodyinto this pickle and will continue to do so if you allow them back into your life. basicallyall the starchy carbs, all bread, all pasta, all cereal, all potatoes, all rice, all grains,all chips, crackers, cookies, bagels, muffins, english muffins, pies, candies, cupcakes,all that deliciousness, alright? these got everybody in the pickle, alright? not justyou guys, everybody in america, okay? we eat

a lot of them. they're nutrient devoid andthey turn to sugar within 30 seconds to two minutes, depending on the source in whichthey came from. that's pretty fast. that's a lot of sugar that we're eating, okay? itdoesn't matter how brown and scratchy it is, it's still turning to sugar. that's the informationyour body is getting. so, when that happens your cells are still not that good at takingin that sugar, alright? we still are struggling with a little bit of insulin resistance andguess what? your body will stop burning fat and store fat that's on you that you've beendoing so well with. it will start burning on that sugar again and not mess with thefat anymore. so that's usually what happens. of course, there's a long biochemical processthat goes into this. for the sake of the large

class today i won't, i promise you i won'tgo into it, but basically we do not want that sugar being converted into fat in your liver.now you will get in to starches, throughout your life, so starches happen right? they'rein mexican dishes, they're in casseroles, they're in chicken noodle soup. i don't expecteverybody to pick out every noodle or every kernel of rice. i understand that, but it'sthe starches that your eating by themselves on purpose that get you. they'll sneak upon you. i'm talking the bowl of pretzels on your co-workers desk. the delicious littlemini cupcakes in the break room at work, alright, just a couple of m&m's everyday from yourcoworkers desk, or from the holiday, from the halloween candy. these are the thingsthat will get you. okay? all right. some cereal

every morning, a muffin, they'll get you.all righty. very cool. okay, so let's talk a little about some pain management. basicallyfolks just take your prescribed pains meds as directed. now when you run out of thatprescription and feel free to keep some liquid tylenol on hand at home and if you have someadditional discomfort. you could easily just sit back down.what about like aleve? yah, typically that works well if you don'thave a history of ulcers, or you haven't had gastric bypass, okay?so everything you take has to be liquid? right now, right after surgery, you bet. you'llbe able to take, you know, capsules, or pills and stuff.later?

absolutely yah. and plus it gets absorbedmore quickly. it's a quicker delivery system. basically folks, when to call us, or whento go to your nearest e.r. if you have any of these symptoms on the monitor, or one ortwo of them or all of them, alright? if you have a fever of greater than 100.5 degreesfahrenheit and it is not being lessened by your tylenol, redness and hot to the touchat the wound site, green pus and drainage, uncontrolled nausea and vomiting, bleeding,abdominal pain, shaking and sweating, okay? these are just symptoms that you need to seektreatment for. so for those of you here in las vegas, feel free to go to north vista,if it's close to your house, if it's safe and it's close to go there to north vista.if you are from the surrounding area, like

bullhead city or pahrump or somewhere, goto your nearest e.r. and for those of you out of town, just go to your nearest urgentcare or e.r. if they don't have a bariatric program in that hospital, or in that clinic,the awesome thing about dr. umbach is that yes, this is his personal cell phone number,up here on the monitor. it is in your binders as well. feel free to have the e.r. doctoror the e.r. staff on call to have them call dr. umbach's personal cell phone number toseek out the best treatment plan for you, okay? he does answer it. when i'm here liveand in person and in my office, his office is next door to mine, so i hear him answerit. all right, so basic tips for life. eat slowly and chew your food thoroughly. eatingquickly will cause severe pain and agony along

with nausea, vomiting, and irritation to yournew baby stomach. so you're going to take a tiny, tiny little bite of your food. you'regoing to chew that 20-30 times and you're going to swallow, okay? it's going to haveto be that slow. with your liquid again sip, sip, sip. alright? introduce that fluid veryslowly. i left this slide on here because it works. many patients have told me and they'veconfirmed that if you've got kids, or grandkids at home, or they come and visit a lot, thenyou still have a little training utensil, dig them out again and use them for yourself.because what we've done in america is that we've created a normal huge serving sizes,like our plates are huge. our serving utensils, now we're eating off of tablespoons, you know?i mean we really do things fast and pretty

big. so what this is going to do is goingto help you slow down and create a new neural pathway for your brain and your eyes. becauseif you're going to look at your little quarter cup of food, okay? it's on a big plate andyou've got a big fork coming at it, you're eyes and your brain aren't going to realizeand believe that this is going to fill you up. you're just going to be that full, likewhat? this food, this is not going to fill me up. this is crazy, but many patients findwhen they start adding textured foods back in to their life, they start with a littlebaby serving size, utensils, and plates and bowls and things like that, because it's goingto take you about 30 minutes to eat a full textured meal, okay? all right. drinking tostay hydrated, because we need to touch upon

this again. basically folks, six to eightservings of water or your fluid a day. drink between meals. you're going to be sipping,sip, sip, sip. do not gulp. all right. so, another thing that i like to share is for folks who areconcerned about becoming dehydrated. keep some pedialyte in the fridge or keep somepedialyte at your house, alright? there's a lot of different delivery systems with pedialytenowadays. there's powders you can add to your water or you can just get a big liter of pedialyteand put that in your fridge. and basically that is the correct ration of electrolytesto hydrate you quickly, much more so than propel and g2 and all of that stuff, okay?those are not the correct ratio. they're not medically formulated to introduce the electrolytesinto your cells quickly, okay?

that was the g2?yah. (laughter) alright guys. all right we have to talk about bubbles. we have to talkabout carbonation alright? bubbles do irritate your stomach. they cause a lot of pain, gas,distention, heart burn, nausea, right? so you're thinking, oh, she's probably talkingabout soda. i'm also talking about beer, champagne, peligrino, ginger ale, soda water, anythingsparkly. for those of you who know what combuga is, that's fermented too. that will causea lot of discomfort, anything carbonated. all right.is that forever, or just for the next two weeks?you know what, mostly it's forever, mostly it is and everybody is different though, butmostly it's forever. (laughter)

no drinking forever?the sparkly, yes. yes. it also means beer and champagne, i know. new year's is comingup. the holidays are coming up, so i have to throw that out there with the champagne.okay. (laughter) you know you're dehydrated when you have these symptoms up here on themonitor, thirst, decreased urine output, strong smelling urine, dark urine, dizziness, orlight headedness, a dry sticky mouth and a headache. these are all reasons, or they're all symptomsof dehydration. all right, so we kind of talked about alcoholic beverages, but as your bariatricnutritionist, this is what i have to say. i am supposed to say that. i am also supposedto say this, right? i am also supposed to say that. i would be a bad nutritionist ifi said "oh hey, go for it, okay." but i know

why it happens, because we know there is nonutritional value in alcohol. we know it's loaded with empty calories, but guess what?i know life happens. life does. you want to go out and enjoy it, right? part of the reasonwhy you're getting this surgery is so you can go out and have a fun and energetic vivaciouslife again. all right? so for those of you that do enjoy some alcohol now and again,a nice glass of wine, a nice cocktail, you can certainly do that for sure. the one thingto think about though is to please make sure that they are not carbonated. another thingto think about folks is that anything that is blended, like a frozen margarita, a frozenblended margarita, a frozen strawberry daiquiri, a pina colada, anything that's like that isjust like a frozen sugar bomb and can cause

dumping syndrome and a lot of discomfort.you don't want that if your out with friends or family. another thing to please keep inmind, you guys, is when you are trying a new drink, a new cocktail, maybe on the menu,or it's your first time out, the holidays are coming up, let your family members, yourfriends, your husband, your wife, your partner know that hey, this is the first time i'mgoing to start having a little bit of a drink. keep an eye on me. i'm not sure how i'm goingto react, because it hits you very quickly. what used to take a glass of wine, or maybea nice cocktail, right, is probably going to take you a quarter of it. okay? so be verycareful, but enjoy yourselves, okay. (laughter) all right. so, any questions aboutthe first two weeks after surgery? all right.

perfect. so we're going to move on to weeksthree and four. so in addition to your 40-60 grams of whey protein shakes a day, becausewe definitely have to keep up with these, right? we have to get our protein in. howelse are you going to get up to 60 grams of protein every day, right? you're going tostart adding some textured foods back into your life, but the goal is to continue pickingand choosing from that funnel diet list that we spoke about earlier and the goal is alsoto keep chewing those foods 20-30 times, okay? slow it down. basically, and i threw thisup here because this usually helps my patients when they start transitioning into texturedfoods. my patients find that they can do very well with one meal, maybe a quarter cup, ora half cup of textured food, which would equal

a couple of bites of the protein and a coupleof bites of a soft vegetable or something, and then they continue with their proteinshakes and smoothies. because now you can make smoothies. see now you've passed thattwo week mark, you can start making smoothies out of your protein drinks, make them funagain, okay, because they've been pretty boring. (laughter) all right. in your binders folkswhen you start leafing through that, there's some really great recipes for smoothies inthere and they've actually been passed down to me from prior patients so, they are bariatricpatient approved, i promise. all right. all right, so foods in this stage can includeground or shredded low fat meats. now the texture we're looking for is perhaps tunafish, or that swanson's canned chicken. you

don't have to eat it, but that's the texturewe're looking for, ground meats, shredded meats, flaky fish, you know, halibut, tilapia,cod, and salmon. that works really well, if you like it. now, you can certainly have leanor white poultry like chicken breast or turkey breast, or lean beef, but i put if toleratedon there for both of them because sometimes those two meats, if they're not prepared well,if they're too dry, they can feel like they're sticking, kind of sticking in your esophagus,or they stick in your stomach a little bit. they are just really hard to, they are tightlybonded protein. they've got a lot of protein bonds in there and it takes a lot of enzymesin your stomach to pull them apart and create peptides and dipeptides. so, yah, but, usuallythe meat found in soup, like chicken vegetable,

or beef vegetable, slow cooked meats, foundis stews and soups, those work really well, okay? okay. okay. obviously we're very familiarwith this greek yogurt and by the way i'm going to talk a little bit about greek yogurt,because i forgot to do it earlier on. folks, for those of you that do yogurt, please, please,please, do only greek yogurt, if you do yogurt at all, okay? greek yogurt is processed muchdifferently in that it's left in the vats of, the big old vats in the manufacturingplant and they allow the bacteria, the beneficial bacteria to ferment much longer then the typicalyogurts out there right? and then these bacteria chomp away, like pac mans, for those of youthat remember pac man, at that lactose, that milk sugar and any remaining milk sugar isstrained off throughout the rest of the process

of making greek yogurt. you are left withthat delicious heavy whey protein. so that's why whey protein is a better choice than theregular proteins out there. we're not counting calories. i don't care if it's fit and lightand 90 calories. it's still sugar. it's still lactose. it's still flavored with a bunchof funny stuff and colored with a bunch of funny stuff, okay? so if you do greek, ifyou do yogurt, please do greek yogurt. you're going to get more bang for your buck as faras protein. all right. so scrambled eggs we know, no sugar-added applesauces. now we'regoing to start adding vegetables back into our life. all right? now, i never thoughtin a million years that i would ever, ever to tell people to cook the heck out of theirveggies. what nutritionist tells people to

do that right? but i've noticed that in bariatrics,this phase, weeks three and four, people do better with vegetables when they are wellcooked. you know, steam the heck out of them, grill the heck out of them, stir fry the heckout of them, okay? make them soft. break down that cellulose and that hemi-cellulose, andit's going to be easier to break down and digest in your stomach. clear broth, soupsand pureed soups. yah, you can start adding some beef vegetable soup and some chickenvegetable soup back in to your life, if you want that, okay? chicken, or yah, chickennoodle, no not chicken noodle, but chicken vegetable, split pea, if you like that. thoseare the things we are looking for. all right. so beware of some of the following. we haven'treally talked about fruit have we? okay. let's

talk a little bit about fruit. i'm going tomake it fast. fruit is sugar. it's candy. so be very careful about fruit, okay? nowa true serving size of fruit, before surgery is the size of a tennis ball. so you knoweverybody in america over eats fruit, when they have your apple a day or their orange,or whatever, because the fruit we have nowadays is huge. they're the size of softballs inthe store, okay? if you can keep your fruit size to, after surgery, okay, to 1/4 cup,which is the serving size approved for bariatric patients, that would be fine. another thingto keep in mind, peel your apple. if you're craving a few slices of apple, peel it first.again, we are only on weeks 3 and 4 and never eat fruit by itself. always have it with aprotein or a fat. have that apple with a little

bit of natural peanut butter, or throw itin your protein drink and blend it up, okay, or with some cheese even, okay? always haveyour fruit with a protein or a fat. yes hi. i have a question.sure. what about canned fruits?yah, same thing, and almost a little worse, because a lot of the fibers are denaturedand broken down, so if you want to eat a few bites of canned fruit, are we talking likecanned peaches? yah.yah, please have that with a protein or a fat or put that in your protein drink andblend it up, okay? make a smoothie with it. alright, very cool. the key, yes, the keyis to keep that serving size to be around

1/4 of a cup. it's just the sugar. okay? it'sjust sugar, it's fructose. all right. so, corn is not a vegetable. it's a grain, okay?corn, corn is my nemesis. i think corn makes everything bad it touches. corn is horriblefor people. so it's a grain, a starch. try to stay away from it if at all possible. it'sin a lot of food so it's almost impossible. watch out for celery, all right? cook it very,very well, or celery in soups are okay, or cooked in a slow cooker is okay. and againasparagus stems and asparagus stalks are very, very fibrous, so you might want to watch outfor those as well, okay? you can have the tips. you can also have broccoli and cauliflower,but i would chop off the floret and just have the floret right now. eventually i promise,you'll have raw veggies, but right now on

weeks three and four, let's just eat the florets.let's just eat the tips of the asparagus, okay? there we go. alright, let's talk aboutfats because fat is a macronutrient, just like carbohydrate and just like protein. youneed to eat it every day to survive, okay? now fat has gotten a bum rap. so dietary fat,healthy fats, like fats found in olive oil, which is a monounsaturated fat is very nourishingfor your body and it's easy to digest in your stomach. coconut oil, another power house.that's a very healing and nourishing fat as well. if you like dressings or mayonnaise,pick the olive oil-based ones, okay? very nourishing for your body and easy to digestand break down, okay? avocados, for those of you who like avocados, again, very richin monounsaturated fats, very nourishing and

easy to digest and break down and we're goingto talk about fish oil and or flaxseed oil in the supplement segment. these are a greatsource of omega three fatty acids, which are great for anti-inflammatories properties andother things. all right. any questions about weeks three and four? awesome, you guys aregood. okay. okay, so let's talk quickly about supplements. supplements are required everyday for the rest of your life and i'm going to make it as brief as possible. i get a littlelong winded on this because there's so much information. so basically folks, supplementsare insurance for complete nutrient intake for the rest of your life. food is where weideally get our nutrients, but if we eat less food, which is the beauty and the magic ofour surgery, right? if we eat less food, we're

getting less nutrients, okay? it goes handin hand. food is where we're supposed to get our nutrients, but we're not eating a lotof food, so we're not going to get a lot of nutrients. this is where, folks, we see hairloss, okay, for those of you concerned about hair loss, weak nails, osteoporosis. so wewant to make sure that our body is getting the building blocks and the nutrients it needsto maintain those functions. hair loss and those kinds of things can be a source of malnutrition.that's all it is. see if you have, of course, a thyroid condition, definitely work withyour primary care doctor about that. that can also cause some hair loss, and maybe someanemia, but again, that's something you'd be working with your primary care practitionerwith. all right, very good. so you have to

take your vitamins every day, you just do.you're never going to be able to eat enough food to get those vitamins. all right. whoops.okay, so, you're going to start your supplement regimen about weeks one or two after surgery.many folks find that if it takes you on to week two after surgery, that's completelyfine. there's a lot of stuff to remember for the first week or two after surgery. we wantto make sure that you're getting your water. we want to make sure that you're protein.we want to make sure that you're healing well. it's a lot to take in and worry about. mostfolks find that they definitely start their supplement regimen about week and a half totwo weeks after surgery and you're going to start with a gummy or chewable, all right?now many folks find that after a couple of

months, maybe six months down the road, they'remore comfortable taking capsules, but right now, or small gel caps, but right now, rightafter surgery, folks, for the next couple of months, i want you to stick with the gummiesor chewables, alright? this starts the digestion in your mouth and it's easier to swallow,so you don't have to slug a bunch of water down, okay? all right, so there's three levelsin the vitamin world, i'm going to make this clear. there's practitioner grade, which iswhat i would ideally like everybody to aim for. these are therapeutically dosed to meetthe needs for bariatric patients. so any formula that's made for bariatric patients is ideallywhat you should be looking for. they're therapeutically dosed to meet any deficiencies that you mayfind in a bariatric patient post surgery,

okay? they have also been tested for cleanliness,for potency, for purity, and for absorption in a simulation, very, very important folksbecause there's a lot of dirty out there on the shelves. there are no regulations forsupplements out there, except for some very self regulated groups out there. so, be verycareful. the brands that i recommend, you should be able to get anywhere, okay? i'vedone my shopping for you guys, so i'm very brand specific with our program. you can prettymuch get them anywhere regardless of what your monthly budget is, because i know mostfolks have different monthly budgets and trying to fit it all in can be a challenge for manyfolks. so here we go. the practitioner brands that are recommended are the celebrate brand,the bariatric brand, the journey bariatric

brand. there's also a brand out there calledbariatric fusion. again folks, these are tested to make sure that you're going to absorb them,regardless of what procedure you had, okay? you're also knowing that they're clean. theproducts are clean. they didn't get them from some country from far away that didn't testfor cleanliness. many of the stuff that comes over from asia and china has impurities inthem, fungus, cadmium, and lead. so you want to make sure that these companies have donetheir homework for you. so you're guaranteed a good product when it's a practitioner grade.another level to think about for wherever you shop, of course, would be stuff in a healthfood store, and i'm talking gnc, not so much gnc, vitamin shops, browns whole foods, vitamincottage, whatever your local health food store

is, if you like to hang out at the crunchygranola local health food store, the co-op, go for it. you're always going to find a goodclean product in those stores because they have high standards. they're not going tolet any old thing come in and be on their shelves, okay? they have high standards forcleanliness, and for sourcing etcetera. the third, i guess, level of vitamins out thereor supplements would be otc or drug mass. this is where the dirty lives. a lot of dirtylives on these shelves. these are the stores i'm going to name, walmart, target, walgreens,costco, sam's club. everybody shops there right? we all find stuff we need at walmart.so i've done my shopping for you. there's a couple of clean brands that are on the shelvesat walmart and costco and things like that.

so, these are the brands that typically workvery, very well for everybody, celebrate, bariatric advantage, journey bariatric. nowthe alive, by natures way you can find that at health food stores, online, and at target,and walmart and walgreens. i've seen them in all three. all right, they are a very,very good clean company and i recommend them, okay?smiths too? smiths? perfect, you bet. yah, many grocerystores now have like a little health section, you bet, absolutely. the vitafusion gummies,come on, you know you've seen those everywhere, right? costco, walgreens, walmart, yah, sam'sclub, they're everywhere and you can definitely find these as well. they're all good cleancompanies. i actually have been through the

manufacturer plants at both those companies.they do have high standards and do pass all the regulations that they place upon themselves.what i'm going to show you in your binders folks is on pages sixty, ah, let's see, sixty-six,yes, pages 66, 65, 67, right here. you'll notice that everything i'm talking about isright here in bright colors. so you'll know when you go to whatever retailer, you've gotit right here. because you know when you go there there's shelves and shelves and setsof vitamins everywhere. it's a little bit overwhelming, isn't it? you never know whatto get. so this is why i have done this. so you're guaranteed to get some good clean productif you stick with these brands. okay. good. so you're going to start with a multi-vitaminokay? that's the first one. the second one

you're going to take is a calcium citrateor a bone health blend, okay? now the calcium citrate is best absorbed by all bariatricpatients. it's co-bonded with a citrate cofactor basically, and we really encourage folks toget a bariatric formula, really encourage it. many folks have a hard time absorbingcalcium anyway. you do not want to take a poorly formulated calcium, okay? you do not.it won't go into your bones, it will bounce around off your bones and end up being inyour blood system causing kidney stones, uric acid crystals and calcification of the arteries.a poorly formulated calcium will cause you more grief than a fairly good formulated calcium,like this. so the bariatric advantage, celebrate, the celebrate one is my favorite. you can get thaton their website, on our website. we do have

an e-store and, or on our shelves here. that'sa really good one. if you notice, if you go out into the waiting room there, you'll noticethat it has a bunch of other things in there. it's going to have boron, magnesium, d3, phosphorous,all of these things work together to get that big calcium molecule into your bones, whereit should go. you don't want it floating around in your blood. we want it to go right intoyour bones. that's where it's supposed to go. so a good bone health formula will haveother things in it besides just calcium citrate. so if you like the chewy caramelly things,bariatric advantage has a good one that's well tolerated by most bariatric patientsas well, okay? so you are going to look for a chewable or a gummy, for sure, for sure.alright, we are going to talk about b vitamins.

this is the third one you've got to take everyday and is very, very important folks. yes your multivitamin will have a nice even amountof your b vitamins, but because you are a bariatric patient you will be at risk forhaving less b vitamins, alright? you're going to burn through them pretty quickly. anybodyon metformin or any other, yep, any other diabetic medication, yes, anybody who is onpain medications, birth control, hormone replacement therapy, these medications burn through yourb vitamins, particularly b12. you burn through b12 anyway, all day. i take extra b12 becausei burn through b vitamins. i burn through my b vitamins just living. if you're a littlekeyed up. if you're a little stressed out, you're burning more b12. you're burning moremagnesium too. so keep in mind as a post surgery

bariatric patient its always good to takeextra b vitamins, even though you've got it in your good multi-vitamin formula, becausethose are the first vitamins that your body will utilize for so many functions in yourbodies, especially if you're stressed out or busy or not eating what you should be eatingand things like that, taking some medications, things like that. so i am going to be a littlepicky though. your b12, all right, your b complex has eight b vitamins in there. there'seight of these guys in the b family. b12 is one of them, okay? b12 is one of them. lookfor the methylcobalamin version, especially for my patients who are having gastric bypass,okay? it's very important that you make sure that your b12, if you take it separately orif it's in the b complex is indeed methylcobalamin

with an m, not a c, not cyanocobalamin, mas in methylcobalamin. this is the active version of b12 and you will absorb it, okay?the other forms are cheaper. they're not as well formulated and you're at risk of becomingshort in b12, or deficient in b12, okay? so look for methylcobalamin, this is the activeversion. so bariatric advantage has a pretty good one. celebrate has a good one. celebrateb50 in your binder, that's a really good formula and it's a wonderful price point you guys.i think we retail it at 11 bucks, so it's a really good one. it's a tiny, tiny, littlecapsule. you could swallow that down with a little sip of water. and folks anything,any vitamin or supplement that you get in capsule form, feel free to break them openand sprinkle them into your protein drink.

okay, so vitafusion makes a gummy. it doesn'thave the b12, methylcobalamin b12 in it, but you know, you may consider taking one of theother, just b12, yes, b12 sublingual, sprays, drops, and injectables work really well, okay?for those of you that get your b12 shots ask your pharmacist or ask your doctor if it isindeed methylcobalamin, okay? alright, let's talk about probiotics. this is where i geekout on nutrition. here we go. probiotics are so important for your immune system and foryour overall health that both the doctor and i want you to start your probiotics rightwhen you get to your hotel room or right when you get home after surgery, all right? itis just that important. it is just that important. all right. so, probiotics, 80 percent of yourimmune system happens in your gut, in your

intestines, 80 percent of your immune system.70 percent of your serotonin production, that feel good neurotransmitter is produced rightin your intestines. these guys are so important they actually help you absorb and assimilatethe food, or the supplements that you're taking. they do a lot for us. anybody that has beenon antibiotics, which is all of us, anybody that has been on pain medications, pharmaceuticalmeds, anybody that has been stressed out, eaten incorrectly, i mean come on, we've alldone that right? these guys will help realign the mucosal barrier in your intestinal wallsand help repair anything that's going on, because we've all heard of e.coli right? we'veall heard of salmonella. we've all heard of h.pylori, although he likes to hang out inour stomach. he causes a lot of grief in your

stomach, but most of these guys like to hangout in your large intestine. many guys like to hang out in your colon. they're very spotspecific, all right? they have jobs to do and some of them hang out in your small intestine,a lot of them hang out in your large intestine and a few hang out in your colon, okay? butwe have all taken antibiotics and we've all been stressed out and we've all eaten incorrectlythroughout life, because life happens right? right? so this wipes out the good guys, justkind of wipes them out, all right? so we need to replace the good ones. now because 80 percentof your immune system happens right here, from the beneficial bacteria, this is themain reason why we encourage patients to take the probiotics right after your surgery. youdon't have to wait the two weeks, okay? all

right. for those who struggle with constipation,there's a couple of key strains that like to hang out in your colon and they do helpwith bowel movements, okay. so you're going to look for a formula that has oh, at least8-12 highly researched bacterial strains, alright? a lot of the ones i recommend areindeed those well-researched strains you're going to get about 12-15 of the ones i recommend.where am i at, right here. oh no, there we go. all right, so we've got orthobiotics,which you've noticed in the waiting room. that's that little jar, that little plasticjar out there that's orthobiotics. this is a powder form and there's a little scoop inthere. you can take one little scoop a day, throw that in your protein drink. you're notgoing to know their there and that's the best

way to take it. however, if you have a favoriteprobiotic, let me know, you know. shoot me an email or dig around in your cabinets athome and see if you have one that you've taken that has worked before and let me know andi'll see if it's going to work for you after surgery. renew life is another very, very,good one. i've seen it at walmart. i've seen it at walgreens and enzymatic therapy pearls.that's a really good one as well and that's a tiny, tiny little pearl-shaped pill. it'sa slippery little guy and that goes down with just a sip of water. those are very good onesand i have seen those at walmart and walgreens as well. but you're always going to find theseat health food stores too, except for the orthobiotics. you're going to have to go directlyto their website or to amazon. that's a practitioner

grade. it's one of those practitioner gradeones i mentioned earlier, okay? all right, so any questions about probiotics? all right,so last one, number five, every day, your omega 3 fatty acids. these are found primarilyin fish oils. if anybody is vegan or vegetarian, or allergic to fish, then there's also flaxseedsor chia seed oil that works very well, that still gives you your omega 3 fatty acids.omega 3 fatty acids are anti-inflammatory, that's the main reason why folks take them.many cardiologists recommend omega 3 fish oils nowadays. it helps keep the arteriespliable. it helps the cell membranes to be receptive to the knock of insulin. it helpsbuild hormones. it helps protect and maintain your neurotransmitters. it also helps withosteoarthritis, this anti-inflammatory. yes,

hi.so you can take the chia seeds. yes, absolutely.do you have to crunch them up? well, not on, after week two you should beable to take them or eat them any way that you like to, you bet, yah, you'll be all healedby then, yah, perfect. okay, so, yes, and many times they also help with bowel movements.they help repair diabetic neuropathy or just nerve damage. their good stuff. we need themevery day. i know you guys don't want to eat sardines and (coughing) every day. who wantsto do that every day right? right? so it's always good to take a supplement. all right,so vitafusion has a really good gummy and you know you've seen it at walmart and target.you know you've seen that at costco. that's

a really good gummy. i've had great responsefrom that from our patients. the schiff krill oil is another really good one, again, veryeasy to find at any major retailer. and again that's a really good one. it's a small, small,small, little slippery gel cap. you can sip that down with a sip of water. now for thoseof you who say, oh i hate taking them, i burp up fish all day, i smell fish. they give meheartburn. more than likely you grabbed a cheap product, one that has been maybe leftin the sun too long on a pallet in some random warehouse, okay? you wanted to save a coupleof bucks you got a really cheap product they didn't test for impurities, right? so thoseare factors to think about. and most of us have impaired digestion, so those are toughto break down too if you have impaired digestion.

so they kind of bounce around (laughter).all right you guys. we all know about vitamin d3. many of you are on it already from yourdoctor. the thing about iron, i always encourage folks to get tested for it. if you're fatiguedit's usually from another reason, please make sure that your doctor did diagnose you asanemic or low in iron before you take iron willy nilly, okay? calm magnesium powder,i mentioned magnesium earlier. we burn through magnesium really quickly, okay? magnesiumis the first one that gets burned through it. it's a very popular mineral in your body.it's used in over 500 functions in your body every day and every night. so we need a lotof it. the calm magnesium powder, you'll notice it next door, if you just want to take a lookat it, that is the best way to get your magnesium,

because it's easy to digest and you can addthat to your water, just like crystal light and use the stevia for the sweetener, or youcan just add it to your protein drink. it's a great way. yes.i didn't see the potassium. potassium?yah, i didn't see that. so magnesium actually helps more quickly thanpotassium for leg cramps, calf cramps, even eye twitches, migrane headaches, constipation,yes, a whole host of things, muscle and joint pain, you know stiff tight muscles, fibromyalgia,things like that. magnesium really, really does help with more things and it helps facilitateany minerals like potassium it helps facilitate those guys into your cells more quickly. magnesiumis the, he's the mother mineral, yah, yah.

good question though, thank you. all right,so these are some really quick tips you guys, you can definitely add crystal light pureto your whey protein, to, you know, alter the flavor if you like. coconut oil, we mentionedcoconut oil earlier. it works on your skin. it helps prevent shrinkles, all right? whenyou lose your body fat, i had a patient actually call it that's why i use it. i'm kind of usingher word. when you lose your body fat your skin may not catch up fast enough and so thoseresult in what we call shrinkles. so coconut oil again is a really inexpensive way to giveyour body essential fatty acids and the oil to help keep your skin supple, okay? all right,okay. let's talk about whey protein powders. now ultimately the cleanest way to get yourwhey is the whey protein powder, the jugs

of protein powder. that is the best way toget your whey. i love saying that. if anybody has a dairy allergy, a dairy intolerance,or your just vegan for ethical or religious reasons, come find me later or shoot me anemail and i can recommend some plant-based protein powders, okay? but, primarily mostbariatric patients do very well with whey protein powder, preferably whey protein isolate,because it does go into your cells very quickly with minimal digestion, okay? so a lot of the brandsthat i put in the binder for you guys, you can find it everywhere. they are really ina lot of retailers, or online, or next door in the waiting room. so i know everybody,we have a lot of folks from out of town too, so i want to make sure that folks do havethe ability to get your vitamins and your

supplements wherever you live. all right?perfect. so these are all some very popular brands, very tasty brands. now lets talk aboutthose ready to drinks, alright, those ones that are already pre made, like premier protein,pure protein and isopure. those are the top ones. now those are the ones that i wouldrecommend. they're the least dirty out of all of them, because there's some dirty onesout there. ensure, boost, glucerna, oh whatever, any equate brand from walmart. i see somespecial k protein stuff, just run screaming from those you guys. have you seen the ingredientsin those? have you seen what's in them? it's nothing more than coffeemate creamer. it'sreally bad. it's poorly digestible protein. it's very cheap protein. it's milk proteinconcentrate, it's soy protein isolate, these

are very irritating and you're body's notgoing to absorb it. all right, so the ones i recommended are pure protein, premier protein,or isopure, which you can get it at almost any retailer and we have some. we have somepremier protein in our clinic too. most patients like that. but also folks, keep in mind thatthese are handy. these should be used if you're at your kids soccer practice, you're at workand you need something in the fridge. if you are running errands, if you're christmas shoppingin the mall, this is where these are going to come in handy. they do have a lot of preservativesand emulsifiers in them because they have to stay fresh a year after they are made.you know these things were made months and months ago and then they get shipped in somehot truck across the country and then get

put on a pallet then get forklifted into thewarehouse and then they get pulled out again by the forklift and then get shipped to theretailer, and then sit in the retailers distribution center and they get pulled and they get onthe retail shelf and they sit there for a couple of months until you pick it up. sothey have to put a lot of these things in there to keep it delicious and creamy whenyou open it, okay? all right. now you're not going to get protein bars until about a monthafter surgery. the reason why is that there dense and they're sticky and they're prettyheavy, but the protein bars that work best are the qwest bars, which you'll see nextdoor. you can also get those at gnc or online. another great brand is the brand called simplywhey, alright? you can see what they are next

door as well. all right, you may want to pickup a few just to have. you can order them online as well. so those are some good bars.they're clean alright? the other ones out there do have a lot of junk in them. i'm sorry,they just do. all righty, so, some really great websites. now if you want to make noteof this one right here, the bariatricfoodie.blogspot.com. this is a website that i put on the presentationreally quickly, it's not in your binder. i have a patient, who is a professional chefand she turned me on about this, so i checked it out. it's the bariatricfoodie.blogspot.com.it's not in there, so write that down really quickly. that has amazing recipes in it andi took her work for it because she is a chef, okay? so yah, it's a really good place toget recipes, the same with bariatriceating.com.

that's another great place to get recipes.and eventually on our website, we're going to have really great recipes, submitted byour patients. so we're working on that, definitely. and, of course, like us on facebook folks.we have a lot of great patients on there that like to encourage everybody else and it'sone thing to join a blog, or forum and talk with other folks, all over the world, or allover the country and get ideas, or encouragement that way, but it's another thing to talk amongstother patients of dr. umbach's and us. you know, it's really fun that way for sure. so,like us on facebook and oh, i think that was it. oh my goodness. that was it, okay. (laughter)there's usually one more on there, but i think we took it off. so anyway, does anybody haveany very quick questions? no? yes, hi.

what about like _______ medications and stufflike that, can you still take those? yes, work very closely with your primary caredoc, or the, you know, the physician that prescribed the medication for you. work very closely withthem and, you know, and just be in tight communication with them to see if, you know, if you can_____ down or what you're going to need as you lose your weight, okay? absolutely, sure.now, folks, if you are on medication and you're worried about, and you're worried about, idon't know how to make that go away, i don't know why that's there, and you're worriedabout taking or swallowing your pills, or your capsules, go ahead and if you feel likethey are too big and you don't want to gulp a big bunch of water to get your medicationdown after surgery, work very closely with

your pharmacist or your primary care doctorto see if he can, you know, give you a different delivery system, you know, maybe separateinto two small capsules, instead of one big one, okay? so there's some ideas there forsure. okay, any other questions? no? folks, make sure never to break open your medication,your pharmaceutical medication and sprinkle that into your drinks, only your supplements,okay, because sometimes those medications are time release.