Food Guide Mini Gastric Bypass Program

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Food Guide

Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Effective Strategies to Healthy Eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 9

I. Reading Food Labels 9 II. Visualizing Your Portion 10

III. Planning Your Meals 10 IV. Weighing Yourself 11

Lifestyle Diary: Rules and Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Pre-Operative Guidelines . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Pre-Op Regime Side Effects . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Post-Operative Guidelines . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

I. Stage | Clear Fluids 23 II. Stage | Full Fluids 24

III. Stage | Puree Foods 26 IV. Stage | Soft Foods 29 V. Stage | Solid Foods 31

Potential Nutrition Complications After MGB Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendix 1 | Pre-Op Regimen Recipes . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix 2 | Post-Op Regimen Recipes . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

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SmartShape™ Food Guide

Congratulations on booking your procedure with SmartShape. You have selected a care team who strives to support patients throughout their journey in order to optimize their health, wellness and weight in a sustainable, safe, enjoyable and nutritionally sound manner.

The Food Guide is a detailed reference tool to help you navigate your pre and post-op journey complete with instructions to follow before and after your procedure, as well as general healthy eating recommendations such as how to read nutrition labels, track your lifestyle, adjust the amount and types of food you eat, how you eat them, and much more!

To compliment the Food Guide, we encourage you to reach out to your team of Dietitians with any nutrition questions or concerns you might have.

We are committed to helping you along your journey.

Sincerely, Registered Dietitians

The SmartShape™ Weight Loss Centre

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Nutrition

We want you to become familiar with basic nutritional information as you start your journey towards adapting new eating habits and making wise healthy food choices.

Nutrients are required by our body every day. There are 6 main groups of nutrients:

1. PROTEIN – Protein is an important part of the structure of all body cells. It is used to build skin, hair and muscle in your body. Your body needs a certain amount of protein each day to stay healthy. You will see proteins mentioned several times throughout the Food Guide because we really want to stress the importance of this nutrient in each and every meal and snack. You should aim for at least 60-80 grams of protein each day.

Measuring Hints

1 oz. of meat is = to about three to four tablespoons of chopped/ground meat. 1 oz. of grated or cottage cheese, tuna or egg salad is = to four tablespoons.

3 oz. portion size of poultry or meat is = the size of a deck of cards.

How Many Grams of Protein in Solid Foods

1 oz. of meat = 7 grams of protein 1 egg white = 7 grams of protein ¼ cup egg substitute =7 grams of protein

¼ cup non-fat cottage cheese = 7 grams of protein ¼ tuna fish in water = 7 grams of protein 1 oz. low-fat or fat free cheese = 7 grams of protein 6 oz. low-fat light yogurt = 8 grams of protein

High Protein Ideas

Chicken or Turkey

Pureed chicken/turkey - try mixing it with strained low-fat cream soup Baked, grilled or poached chicken/turkey breasts

Thin sliced or shaved deli slices Meatballs or meatloaf with ground chicken/turkey

Chicken/turkey salad

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Fish

Baked, broiled, poached or grilled fish Shrimp, imitation or real crab

Fresh or canned salmon in water Canned tuna in water and other canned fish

Sushi

Beef or Veal (Extra Lean) Meatballs, meatloaf and potted beef in lean ground beef/veal

Pork Shaved deli ham or deviled ham

Eggs or Egg Substitute

Scrambled eggs or omelet Homemade eggnog made with skim milk

Diet custard Egg salad

Quiche or frittata Deviled eggs

Low-Fat Dairy Products

Milk (skim or 1%) Yogurt (plain or low fat)

Low-fat cheeses including cottage or ricotta

Legumes Hummus

Smooth peanut butter Dried beans or lentils in soups, stews or chili

Vegetarian or fat-free refried beans Tofu

Additional Ideas for Adding Protein to Foods

Consider adding the following items to low fat milk, yogurt, cottage cheese, hot cereal, de-caffeinated coffee/tea, low fat cream soups, mashed potatoes, casseroles, applesauce or eggs.

Non-Fat/Skim Milk Powder 1/3 cup powder = 8 grams of protein

Egg White Powder

2 tbsp = 6 grams of protein

Nestle Beneprotein 1 scoop = 6 grams of protein

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2. CARBOHYDRATES– Carbohydrates are essential for mental and physical functioning. They are

found in foods that contain starch, sugars and fiber such as fruit, milk and alternatives and grain products. Starch and sugar break down into glucose (the sugar in your blood). Glucose is what your body uses for energy. Too much carbohydrate can make it challenging to manage health and weight, especially for those living with diabetes or glucose intolerance.

Choose high fibre carbohydrates most often as they provide the most satiety as well as nutrition. Some examples include: fruit; whole grains like rolled oats, steel cut oats; brown or wild rice, barley, quinoa; roasted potatoes with the skin on or sweet potatoes. Foods high in sugar and starch should be avoided due to their typically high caloric content. Consuming high calorie foods can result in a loss of control over blood sugar, slower weight loss and even weight gain. You should avoid soft foods as they do not contribute to satiety. Soft, high calorie foods include cookies, cake, chocolate, ice cream, doughnuts, brownies, pastries, frozen yogurt, sweetened cereals, fruit canned in syrup and regular jams, jellies & preserves. High calorie liquids include milkshakes, fruit juice, soft drinks and alcoholic beverages.

3. FAT– Fat is used to cushion body organs and protect nerve cells. However, most people eat much

more fat, than what is actually needed. If you are not getting enough carbohydrates, fat can be changed into glucose for your body to use for energy. Conversely, if you consume too many carbohydrates, your body can convert the excess into fat.

Avoid eating close to the bone (i.e. ribs, thighs) or fat pads around the bone Avoid fried foods - remove all visible fat and skin from meats and poultry Avoid “fast food” as these are usually high in fat Choose lean/low fat products Avoid high fat dairy products such as whole milk, full fat cream, cheese or cream sauce Avoid high fat pastries, donuts and desserts Avoid high fat meats such as bacon, sausage and hot dogs Limit added fats such as butter, margarine, lard, mayonnaise or spreads and salad

dressing. Try the low fat alternatives Avoid snack foods such as potato chips, tortilla chips, cheese curls

You need a small amount of “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter or avocado). However, even healthy fats are high in calories, so they need to be limited to no more than 2 – 3 tbsp per day. Some pre-packaged or prepared foods can be very high in fat. These foods will be much higher in calories when compared to low-fat foods in the same food group. Unless you read the labels, you may not know which foods are high in fat. We recommend you choose products with less than 15% Daily Value of fat per serving. The following chart lists each category with low-fat, medium-fat and high-fat foods. *Proteins, carbohydrates and fat all contain calories. Calories can be described as a measurement of energy. If you eat more calories (energy) than you use in a day, your body will store the extra calories as fat. It does not matter where the extra calories come from, your body will always store extra calories as fat.

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Low-Fat Medium-Fat High-Fat Food Group Choose these most often Choose these 1 -2 times

a week Choose these no more than 1 time per week

Breads, Cereals, Starchy Vegetables, &

Grains

Whole grain loaf bread, pasta, rice, potato, oatmeal, grits, cream of wheat, low-fat boxed cereal, corn, peas, kidney beans, pinto beans, black beans, pretzels, bagels

Biscuits, cornbread, muffins, low-fat crackers

Yeast rolls, dinner rolls, croissants, high-fat crackers, potato chips

Milk & Yogurt Skim milk, fat-free yogurt 2 % milk Whole milk, regular yogurt

Proteins Chicken, turkey, lean cuts of beef, lean cuts of pork, low-fat cheese, tuna fish packed in water, baked fish, egg whites, egg substitute, shellfish, fat-free cottage cheese, wild game

Regular ground beef, low-fat hot dogs, turkey bacon, turkey sausage, mozzarella cheese, ricotta cheese, feta cheese, ribs, whole eggs

Sausage, salami, bologna, regular hot dogs, American cheese, cheddar cheese, Swiss cheese, bacon

4. VITAMINS– Vitamins do not provide calories for your body, but they are very important! Vitamins

play a vital role in every chemical process that happens in your body. Even though vitamins cannot be changed into energy, they are used by your body to change other nutrients into energy. The vitamins are A, Thiamin (B1), Riboflavin (B2), Niacin (B3), B6, B12, C, D, E, K, Folate, Panthothenic Acid and Biotin.

5. MINERALS– Like vitamins, minerals do not provide energy for your body, but they do play an

important part in your body’s chemical processes. The main difference between minerals and vitamins is that minerals are smaller and less complex than vitamins. Some of the minerals that your body needs are Calcium, Phosphorous, Potassium, Sulfur, Sodium, Chloride, Magnesium, Iron, Zinc, Copper, Manganese, Iodine and Selenium.

6. WATER/FLUIDS– Most people need at least eight cups (64oz.) of fluid each day. If you do not get

enough, you will likely become dehydrated and can feel weak and tired or even hungry. We recommend sipping on water all day between meals. Consider having 1/3 cup water every 15 minutes. Sucking on ice will also help contribute to fluid intake.

Fluid intake is also important to managing digestive health including diarrhea and constipation. Adequate water is essential to help rid the body of waste, maintain proper muscle tone and elasticity of your skin. Most fluids should be calorie free such as water, Crystal Light, decaffeinated coffee/tea, unsweetened or artificially sweetened tea or broth. Please avoid all sugar sweetened and carbonated beverages as it is a source of high calories with lots of gas. We recommend that you restrict alcoholic beverages as much as possible since they do not have nutritional value, can affect your physical and mental function, and can cause weight gain, ulcers, gastritis and/or liver

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damage. We also recommend limiting your caffeine intake to no more than 320mg/day (approximately three, 250mL cups/day) to avoid dehydrating effects and avoid interactions between caffeine and your calcium levels.

Type of Nutrient Type of Foods Benefits Calcium Milk, cheese & yogurt Builds healthy bones and teeth

Carbohydrate Breads and pastas Vegetables and fruits Honey Sugar Milk

Provides calories or energy ready for your muscles and your brain to use

Cholesterol Dairy products Egg yolks Meat

Helps to make hormones and cell membranes Bile salts are used to digest foods

Fat Butter, margarine, oils Baked goods Milk, cheese, ice cream, yogurt Processed meat Beef, pork, lamb, veal, chicken Nuts

Provides calories or energy Carries & stores vitamins A,D, E, K Insulates the body against the cold Cushions the skin, bones and internal organs

Fiber Whole-grain breads, cereals and pastas

Vegetables, legumes and fruits

Aids in bowel regularity Reduces risk of colon cancer Lowers blood cholesterol

Iron Red meat Whole grain breads and cereals Raisins

Produces red blood cells that carry oxygen throughout the body

Protein Milk, cheese, yogurt Eggs Meat, poultry, fish Nuts, peanut butter Baked beans

Builds and repairs body tissues Minimizes hair loss

Trans Fat Hydrogenated fats Oils found in deep fried

products and baked goods

None

Saturated Fat Butter, cheese, whole milk Sour cream Ice cream Lard, shortening Red meat

None

Sodium Sodium or salt occurs naturally in many foods but is also added to processed foods such as bacon, soups & potato chips

Balances body fluids Helps transmit electrical signals through

nerves

Sugars Milk Fruits Vegetables Sweetened soft drinks Candies

Provides calories or energy ready for your muscles and brain to use

Vitamin A Carrots Squash Dark green leafy vegetables

Maintains healthy skin Provides good night vision

Vitamin C Citrus fruits Strawberries

Builds and maintains connective tissues Fights infections

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Effective Strategies for Healthy Eating

Getting to your optimal health and weight loss goals will require effort and dedication on your part. It is important that you follow the dietary guidelines and optimize how much physical activity you get, to enhance your long term success. We have developed some ideas for you to embrace during your journey to acquire new healthy nutritional habits. I. READING FOOD LABELS

Knowing how to use information on food packaging can help you make better food choices and thus achieve a healthy regimen. Manufacturers provide information in three ways: nutritional claims, ingredient lists and the nutrition facts table. All of these terms are based on standard serving sizes. Notice the key words follow the same pattern for each nutrient: Free has the least amount Very low and Low have a little more Reduced or Less always mean the food has 25% less of that nutrient than the

reference version of the food

Ingredients are listed in order from the most to the least. The earlier you see an unhealthy ingredient listed, the less healthy the food product is for you.

%Daily Value: This figure indicates how this one serving fits into a 2,000-calorie diet. You should eat no more than 100% of each nutrient each day and no less than 100% for each vitamin and mineral every day. Quick guide: 5% or less is Low and 20% or more is high.

Fat: Pay attention to saturated and trans fats. Apart from the nutritional facts, search the ingredient list for words like “hydrogenated” or “partially hydrogenated” to determine if this product has trans. fat.

The HIGHER the better (applies to everything in this section)

The HIGHER the better

The LOWER the better

The LOWER the better

The LOWER the better

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Fat Fats can be saturated, unsaturated (i.e. monosaturated and polysaturated) and trans fats. Trans fats are bad for your heart and should be avoided. We recommend looking in the ingredients section for phrases such as ‘hydrogenated’ or ‘partially hydrogenated’ fat, oil or shortening, to learn if they are present in the food you are buying. Hydrogenated or partially hydrogenated foods likely contain at least some trans fat and should be avoided whenever possible. Saturated fats should be kept to smaller amounts as they can impact cholesterol levels. You can reduce your intake of saturated fats by choosing leaner cuts of meat and lower fat diary, and limiting the use of butter, coconut, and palm oils. Sugar To find out whether a sweetener has been added to a food (beyond sugars that are naturally present), look for terms such as sugar (sucrose), fructose, maltose, lactose, honey, syrup, corn syrup, high fructose corn syrup, molasses and fruit juice concentrate. High fructose corn syrup is particularly harmful because it is stored directly as fat in the liver and is harmful to the liver. II. VISUALIZING YOUR PORTION

Learn to visualize your portions (see box below). Review your choices and food record with the dietitian.

Visualize Your Portions

Food Item Portion size Visual Object Meat, Poultry, Fish (tuna / salmon) 3 Ounces Deck of Cards Flesh White Fish (flounder / sole) 3 Ounces Checkbook Olive Oil or Salad Dressing 1 Tablespoon Water Bottle Cap Peanut Butter 2 Tablespoons 1 Shot Glass Butter / Margarine 1 Teaspoon Postage stamp Berries / Melon 1 Cup 1 Baseball Pasta, cooked 1/2 Cup Computer mouse Popcorn 3 Cups 3 Baseballs Pretzels 1 Ounce / 1/4 Cup 1 Tennis Ball Bread 1 Ounce CD Case Hard Cheese 1 Ounce 4 Dice

III. PLANNING YOUR MEALS

It is recommended that you choose foods that are high in protein and fiber. Since you will likely be eating smaller amounts of foods, you need to make sure you are getting the best nutrition. In addition, protein and fiber help keep you satisfied for longer. Protein – to get the right amount of protein, you should include a good source of protein at each meal and snack. You should aim for at least of 60 - 80 grams of protein each day as this will help fight off hunger and maintain nutrition status, muscle mass, and allow your body to burn fat when you lose weight. Once you begin to eat solid foods, it is recommended not to drink high calorie meal replacement shakes unless it is suggested by the clinic staff.

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Low-fat – You should have no more than three servings of fat during your meals each day. One serving usually equals one tablespoon. If you use a low-fat version of these foods, a serving equals one tablespoon. If you use a fat-free version, you do not have to count that as a serving of fat. The foods included in this group are margarine, mayonnaise, salad dressing, canola oil, olive oil, peanut butter, cream cheese, sour cream, shortening and butter. Liquids – Limit the amount of calorie-containing beverages because they do not contribute to the feeling of satiety and may prevent ideal weight loss. The goal is to choose satisfying foods to prevent you from overeating at meal time, as well as to minimize snacking throughout the day. This will not only help you to lose weight but also help maintain weight loss and health. Healthier Dining Out Habits – Research has shown that people tend to underestimate the quality and amount of food consumed when eating out. We understand this is an obstacle that patients face every day. Therefore, we recommend practicing portion control at home so you can become comfortable determining serving size when eating out. If you eat out, we suggest you avoid restaurants that serve deep fried foods with rich sauces. It is much healthier to find a salad bar, sandwich shop or a sit-down restaurant where you can customize your order. We suggest you order meals with protein and fibre compliments. Another great tip is to look at the online menu of the restaurant in advance to determine any special requests before you get to the restaurant. This is will able you to make wise choices without feeling pressured. We recommend ordering baked, grilled or steamed foods as opposed to fried foods. Try to choose the smallest size regardless of the price difference or try sharing your meal with a friend, or taking home half the meal for consumption the next day.

IV. WEIGHING YOURSELF

We recommend that you weight yourself no more than once a week. Do not let the numbers on a scale determine your mood. Remember they are just guidelines of how you are doing, but not how we define success. Non-scale victories are very important and generally a more satisfying way to measure progress. You need to learn to identify the feeling of satiety and respect the feeling of not overeating. It is important to be patient along your journey. Losing weight is a steady process that may be more gradual than you wish. However, you will be losing weight and keeping it off in a very healthy way. Be patient with yourself and remember to also acknowledge and celebrate non-scale victories including quality of life improvements.

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Lifestyle Diary | Rules & Hints

From time to time, you may decide or be asked to complete a lifestyle diary. The information you record in your lifestyle diary will help you design an eating pattern to meet your unique needs, bring forth patterns, and assist you in reaching your personal self-management goals. Studies have shown that keeping track of your intakes and behavior for a few days can help you make significant, positive changes in your eating habits.

Write down everything you eat and drink for 3 days. Try to choose 2 days during the week and 1 day on the weekend as our intake patterns tend to change. Do not try to change your eating habits during the 3 days of record keeping. Keep in mind that not all days should be completely “typical” as we want to ensure we analyze and reflect on even our poorest management days.

Helpful Hints 1. WHEN: Indicate the time of day to determine gaps of time between all intakes, beverages included. 2. HOW MUCH: Indicate the amount of the particular food item you ate. Estimate the size (2”x1”x1”), the volume (1/2 cup), the weight (2 oz.) and/or the number of items of that type of food (i.e. 6 pretzels). 3. WHAT KIND: Write down the type of food AND fluid you ate/drank. Be as specific as you can. How was the food cooked? Was it grilled, fried, steamed, or baked? Was it fresh, frozen or canned? If you eat bread, is it white, wheat, whole wheat, rye, honey wheat or multigrain? If you drink milk, it is whole, 2%, 1%, skim, soy, or rice milk? Remember to write down “extras” such as sauces, gravies, salad dressing, mayonnaise, butter, sour cream, sugar and ketchup.

4. ACTIVITY: List any activities you were doing while you were eating. Be sure to include where, such as the cafeteria at work, your desk, a specific room in the house, etc. If you ate at a restaurant, fast-food chain or your car you should record the location as well. Also detail who you were with. If you ate by yourself, write “alone”. If you were with friends or family members, list them. 5. HUNGER and SATIETY SCALE: 1 = not hungry 2 = somewhat hungry 3 = moderately hungry 4 = very hungry 5 = starving

7. COMMENTS: Write down your mood, thoughts, and feelings while you were eating - for example, sad, happy, bored, stressed and depressed. This is a very good and important way to track your “negative” emotions and triggers. Tips 1. WRITE DOWN EVERYTHING: Keep your diary with you all day and write down everything you eat AND drink. A piece of candy, a handful of pretzels, a can of soda pop or a small donut may not seem like much at the time, but over a week these calories add up!

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2. DO IT NOW: Record your eating and drinking as you go. Do not depend on your memory at the end of the day. 3. REQUEST FEEDBACK FROM YOUR CARE TEAM: Be sure to reach out to your care team if you are facing challenges or are interested in feedback; therefore, bring your completed lifestyle diaries with you/email/fax for your next appointment. You can also request a fillable template document to make it easier to complete and send back for analyses and feedback. Exhibit 1 – Daily Lifestyle Record

INTAKE TIME AMOUNT FOOD / BEVERAGE DESCRIPTION

ACTIVITY DURING INTAKE

HUNGER SCALE

SATIETY SCALE

COMMENTS

Breakfast AM Snack Lunch PM Snack Dinner Evening Snack

Exhibit 2 – Daily Lifestyle Record for Individuals Living with Diabetes

INTAKE TIME AMOUNT FOOD / BEVERAGE DESCRIPTION

ACTIVITY DURING INTAKE

HUNGER SCALE

SATIETY SCALE

COMMENTS

Blood sugar before BREAKFAST:

Breakfast Blood sugar (2hrsAFTER BREAKFAST):

Blood sugar before AM SNACK: AM Snack

Blood sugar (2hrs AFTER AM SNACK): Blood sugar before LUNCH:

Lunch Blood sugar (2hrs AFTER LUNCH):

Blood sugar before PM SNACK: PM Snack

Blood sugar (2hrs AFTER PM SNACK): Blood sugar before DINNER:

Dinner Blood sugar (2hrs AFTER DINNER):

Blood sugar before EVENING SNACK: Evening Snack

Blood sugar (2hrs AFTER EVENING SNACK):

*** Blood sugar goals (subject to change): BEFORE Meals: 4-7 mmol/L AFTER Meals: 5-10 mmol/L or 5-8 mmol/L if A1C targets are not being met. Exhibit 3 - End of day checklist. Check off the options that describe your intake for the day � I maintained a buffer of at least 45 seconds between my food and beverage swallows � I drank eight, 250ml, cups of fluid � Meal volumes were no more than 1 side plate � I had protein at every meal � I had high fiber vegetables � I ate at least one fruit � I had at least one milk & alternative

� I took my time when eating � I did not eat closer than two hours � I did not get my food 'caught' while eating � I did not eat further than 4 hours

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Pre-Operative Guidelines

In order to prepare you for your procedure, your surgeon will prescribe SmartShape™ Shake prior to surgery. The amount of time you will be on SmartShape™ Shake will depend on your surgeon’s assessment at the time of your consultation. The purpose of the pre-op regimen is to reduce the fat content and size of the liver through the process of ketosis, not simply to lose weight. By reducing the size of the liver, it makes the surgery more efficient and safer with significantly reduced risks of complications.

1. SmartShape™ Shake is a specially designed, bariatric-specific low carbohydrate, low calorie, high protein meal replacement. The formula was created to supply individuals with distinct and essential daily requirements of macro and micro-nutrients to prepare the body for surgery. Individuals should aim to consume all three shakes daily.

Helpful Tips

We recommend drinking at least 64 oz. (8 cups) of fluid each day Avoid sugar, milk or cream in your decaffeinated coffee or tea. You may use calorie free sugar substitutes such as Sweet & Low, Equal or Splenda/Sucralose Eliminate sugar sweetened carbonated beverages and limit the consumption of sugar-free,

carbonated beverages Eliminate alcohol intake and avoid excessive caffeine intake in an effort to avoid post-op

withdrawal symptoms such as headaches Begin to plan a schedule for your mealtimes and fluid consumption that reflect your own personal schedule

Tweak the Texture & Add Flavor to Your Protein Drink

Sugar free flavor extract or spices can be added (i.e. vanilla or almond extract, cinnamon or nutmeg) Sugar-free cocoa powder can be added to provide a chocolate flavor Make a Frappuccino by adding instant decaffeinated coffee with lots of ice to your meal replacement shakes Sugar-free Crystal Light powder If your drink is too sweet or thick, try adding more water Make a ‘hot chocolate’ by warming your chocolate shake up in the microwave/stovetop Make popsicles, ice chips or a frozen slushy treat by freezing your protein drink For tips, check out Appendix 1 for “Scrumptious SmartShape Shake Recipes”

3 daily servings

SmartShape™Shakes

250 calories specific low

glycemic index vegetables

Mandatory Vitamin

supplements regime

PRE-OP MEAL PLAN

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2. Low Glycemic Index Vegetables. In addition to three servings of shakes per day, you should include a maximum of 250 calories of specific, low glycemic index vegetables per day. There are particular portions specified for each glycemic vegetable that is ‘authorized’ for consumption, so please refer to the following pages for a complete detailed list. Helpful Tips

Avoid meat, poultry, seafood, dairy products, grain products, fruits, broths, juices including vegetable juice blends, salt, oils, balsamic vinegar, and butter Check out of the “Pre-Op Regimen Recipes” (Appendix 1) in for recipes and ideas on how to flavor your vegetables

3. Vitamin Supplement Regime. To ensure your body receives complete nutrition in the days leading up to your procedure and during your post-op stage, it is MANDATORY that you initiate specific vitamin supplements every day for the rest of your life. You should consult with your doctor or pharmacist before starting any vitamin supplement to ensure it is safe to do so. It is your responsibility to purchase the vitamin supplements; the pharmacy will not be including vitamins in their package of prescription medications

Chewable/Liquid Vitamin Supplements

Celebrate Vitamins Multi-Essentials 2 in 1 Chewable

• Take 2 Celebrate tablets, twice daily (4 total)

Purchase Celebrate from: https://www.celebratevitamins.ca/products/essential-multi-2-in-1-chewable

Iron (Ferrous sulfate in preferred; ferrous fumarate or gluconate can be used as well)

• Pre-menopausal women: Typically require 45-

60mg/day. Please ask your GP what dose is appropriate for you.

• Post-menopausal women: Typically require 18mg/day. Please ask your GP what dose is appropriate for you.

• Men: Typically require 18mg/day. Please ask your GP what dose is appropriate for you.

Please speak to your GP to determine an appropriate dose of iron to take pre and post-op and ensure your GP is monitoring your levels with bloodwork. Purchase from: Local Pharmacy

IMPORTANT NOTES:

• Women of childbearing age: Bariatric supplements may contain some vitamin levels considered inappropriate for pregnancy. If you plan to become pregnant (it is recommended to wait 12-18 months after surgery), please discuss your current bariatric supplement regime with your GP/OB prior to becoming pregnant and follow their recommendations for supplements during pregnancy.

• **Patients must separate iron and calcium containing supplements by 2 hours for proper absorption. It is also best to avoid taking iron within 2 hours of calcium rich foods, caffeine or tea. Take iron with 250-500 mg Vitamin C for better absorption.

• After 21 days post-op, capsule options are also available, but with different dosing instructions. Please speak to your Dietitian Team.

Example Schedule: After breakfast: 2 Celebrate Chewable Tablets

After lunch: 2 Celebrate Chewable Tablets After dinner: Chewable or Liquid Iron**

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4. Special Considerations. If you are an individual living with diabetes, please take special precautions when you start your pre-operative regimen. You should check your blood sugar at least four times per day and adjust your medications accordingly. Due to the reduced carbohydrate content, you may need to reduce your diabetes/blood sugar medications by up to ½ and notify your physician who monitors you.

I. WHAT IS LOW BLOOD GLUCOSE? According to Diabetes Canada (www.diabetes.ca), when the amount of blood glucose (sugar in your blood) has dropped below 4 mmol/L. It is also called hypoglycemia. This particular blood sugar level may also have you feeling:

Shaky, light-headed, nauseous Nervous, irritable, anxious Confused, unable to concentrate Hungry Your heart rate is faster Sweaty, headachy Weak, drowsy A numbness or tingling in your tongue or lips

Low blood glucose can happen quickly, so it is important to take care of it right away. If your blood glucose drops very low you may:

Become confused and disoriented Lose consciousness Have a seizure

II. HOW DO I TREAT LOW BLOOD GLUCOSE? As per the Diabetes Canada guidelines (www.diabetes.ca), if you check your blood sugars and you are truly below 4mmol/L, you must eat or drink a fast-acting carbohydrate (select only ONE):

15 g of glucose in the form of glucose tablets (preferred choice, for example 4 DEX-4 tablets) 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water 175 mL (3/4 cup) of juice or regular soft drink 6 Life Savers® (1=2.5 g of carbohydrate) 15 mL (1 tablespoon) of honey

Note: Most individuals prefer to invest in the glucose tabs as they are convenient, not at risk of early expiry, require no planning, and typically contribute the least amount of calories to correct a low blood sugar versus an alternative treatment option. Wait 10 to 15 minutes and then check your blood glucose again. If your blood sugar is:

Still less than 4mmol/L, treat again Greater than or equal to 4mmol/L, consume a nutritious intake (i.e. SmartShape ShakeTM)

within 60minutes

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If you are encountering repeat low blood sugar episodes, you should follow up directly with your health care practitioner who manages your diabetes medications as there is an immediate need to adjust the prescription. Also, be cautious and safe; do not operate heavy machinery after experiencing high or low blood sugars. Also consider that corrections for blood sugars lows involves the addition of calories and carbohydrates to your daily intake, which we ideally want to avoid. Therefore, it is best to prevent lows from occurring in the first place.

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Serving and Calories of Raw or Steamed/Boiled Vegetables (Maximum 250 calories per day)

Please note that manipulating foods (i.e. cooking) alters their glycemic index and glycemic load values per serving; therefore, it is essential that you take into consideration how many servings you plan to consume and whether the item is in its raw or cooked form. Refrain from cooking things into a sauce, puree or soup unless you account for the larger number of servings this type of preparation process would require.

VEGETABLE

SERVING SIZE CALORIES (KCAL) VOLUME WEIGHT (g)

CHOOSE MOST OFTEN (very low glycemic) Alfalfa sprouts, raw 250mL 35 8 Artichoke, canned 1 heart 27 14 Arugula, raw 250mL 21 5 Asparagus, boiled 6 spears 90 20 Beet greens, boiled 125mL 76 21 Beet greens, raw 250mL 40 9 Bok choy, cooked 250mL 180 20 Bok choy, raw 250mL 74 10 Cabbage, boiled 250mL 115 14 Cabbage, raw 250mL 74 18 Celery, raw 1 stalk 40 6 Chili pepper, red/green 1 pepper 45 18 Chive, raw 100mL 20 6 Collards, raw 250mL 38 11 Cucumber, raw / peeled 250mL 126 15 Dandelion greens, boiled 125mL 55 18 Endive, raw 250mL 53 9 Garlic, raw 1 clove 3 4 Green onion, raw 1 medium 15 5 Lettuce, iceberg 250mL 76 11 Lettuce, romaine 250mL 59 10 Lettuce, spring mix 250mL 71 13 Mushrooms (white), raw 125mL (3 medium) 51 11 Okra, boiled 4 pods 44 8 Okra, raw 4 pods 48 16 Radish, raw 250mL 123 20 Rhubarb, raw 1 stalk 51 11 Snap beans (yellow / green), raw 10 beans 55 17 Spinach, boiled 125mL 95 22 Spinach, raw 250mL 32 7 Swiss chard, boiled 125mL 92 18 Swiss chard, raw 250mL 38 7 Turnip, boiled 125mL 82 18 Watercress, raw 250mL 36 4 Zucchini, raw 250mL 119 20

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VEGETABLE SERVING SIZE

CALORIES (KCAL) VOLUME WEIGHT (g) CHOOSE LESS OFTEN (moderate glycemic)

Broccoli, raw 250mL 93 32 Brussels sprouts, boiled 4 sprouts 84 30 Brussels sprouts, raw 4 sprouts 76 33 Cauliflower, boiled 250mL 13 30 Cauliflower, raw 250mL 106 26 Celery, boiled 250mL 158 29 Collards, boiled 125mL 100 26 Cucumber, raw with skin 250mL 126 20 Dandelion greens, raw 250mL 58 26 Eggplant, raw 250mL 87 21 Kale, boiled 125mL 69 19 Kale, raw 250mL 71 35 Mushrooms (portobello), grilled 250mL 128 37 Mushrooms (white), cooked slices 250mL 114 30 Pepper (green), raw 250mL 157 31 Radish, boiled 250mL 155 26 Snap peas (yellow / green), boiled 125mL 66 23 Tomato, boiled 1 medium 123 21 Tomato, raw 1 medium 123 22 Turnip, raw ½ medium 61 17 Zucchini, boiled 250mL 190 29

VEGETABLE SERVING SIZE

CALORIES (KCAL) VOLUME WEIGHT (g) CHOOSE ONLY ONE ITEM FROM THIS LIST IN THE SERVING SIZES DETAILED BELOW OR LESS, AT A MAXIMUM

INTAKE OF ONCE A DAY (high glycemic) Eggplant, boiled 125mL 53 19 Kohlrabi, raw 125mL 72 20 Onion, raw 60mL 42 17 Pepper (green), boiled 125mL 72 20 Pepper (red / yellow), boiled 125mL 72 20 Pepper (red / yellow), raw 125nL 79 25

REMOVE VERY HIGH GLYCEMIC ITEMS COMPLETELY DURING PRE-OPERATIVE REGIME Onion, boiled Vegetable Juice Blends Soy Squash

Kohlrabi, boiled Peas Potato /Sweet Potato/Yam Pickles

Fruit Carrot Beet Legumes

Beans Shitake and Brown Mushrooms raw & cooked Parsnip

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Pre-Op Regime Side Effects

HUNGER Ensure to consume:

All 3 meal replacements daily; aim to have them at regular meal times. If this does not work, consider making the 3 meal replacements into 6 mini shakes taken evenly throughout the day Up to 250 calories of the specific vegetables All vitamin supplements daily Adequate fluid for hydration (2.5 – 3 liters per day)

Do not consume / nibble on items outside the regime, it makes hunger (and other pre-op symptoms) worse and may send you back to pre-op day 1.

Be patient. Symptoms subside within 3 – 5 days of starting regime.

Consider not preparing food for others and/or eating in the company of others, if you think it will be challenging for you to continue your pre-op regime.

HEADACHE Ensure to consume:

All 3 meal replacements daily; aim to have them at regular meal times Up to 250 calories of the specific vegetables All vitamin supplements daily Adequate fluid for hydration (2.5 – 3 liters per day)

Be patient! Symptoms subside within 3 – 5 days of starting regime.

Consider taking regular Tylenol for symptom relief.

Note: reducing your caffeine intake can cause headaches, which is best tackled in pre-op than post-op.

DIARRHEA Give your body time to adapt to this drastic change in diet Opt for a variety of vegetables as they offer fiber, which can improve stool consistency Increase fluid intake to make up for losses and ensure you stay well hydrated Consider the addition of a fiber supplement such as Inulin (ie. Benefibre) or Psyllium (ie.

Metamucil). If you can find it, we prefer sugar-free fiber supplements

NAUSEA Do not take vitamin supplements or medications on an empty stomach Try consuming liquid shake with solid vegetables Remain upright during and after intakes Consider taking non-drowsy Gravol to help alleviate symptoms

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Post-Operative Guidelines

As you recover from your procedure, we recommend a gradual process where you will be introduced to foods of increasing texture and density. These foods will be introduced in defined stages that will minimize the risk of blockage and vomiting. It is very important that you follow these guidelines in order to give your stomach time to heal and achieve maximum benefit. In order to achieve your desired outcome and weight loss, you need to be an active participant in your care. You should intentionally choose a smaller portion of food than you are used to. Careful consideration should be given to the quality of food you eat to help you feel full. The overall strategy is to feel a sense of satiety with the smaller portion of food. With the MGB, the goal is to feel satisfied with a small portion of good quality food. “20:20” Rule It is very important that you focus on chewing your food well and eating slowly. Each bite of food should be chewed at least 20 times and each meal should last at least 20 minutes. Many individuals prefer to eat protein-based foods first in case early satiety kicks in before you has a chance to consume it. Then consume vegetables followed by grain products or starchy foods. “45 Seconds” Rule Patients should wait a minimum of 45 seconds between a swallow of solid food and sip of a liquid beverage. High calorie liquids such as ice cream, milkshakes, chocolate, milk, fruit juices and alcohol will provide you with plenty of calories, but will not contribute to satiety and may upset your stomach. It is important to minimize the amount of air you ingest. Avoid using a straw, consuming carbonated beverages, and/or gulping/chugging. Vomiting By adhering to this progressive plan we are confident that the risk of vomiting can be minimized. Helpful Items For meal preparation For medications

- Mini food processor/food chopper - pill crusher - Hand Blender or the “Magic Bullet” - large pill case (1week worth) - Measuring spoons and cups

Other items - Baby spoon, cocktail fork (helps you to take small bites) - Small decorative plates (helps control portions and increases the eye appeal of the meal) - Insulated dish or warming plate (helps keep food warm while you slowly enjoy your meal) - Sipping cup (for those that have difficulty breaking the habit of gulping liquids) - Extra ice cube trays

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- Small freezer bags - Small plastic containers - The FoodSaver™ to vacuum pack foods

Anticipated Progression Schedule It is important not to advance the progression of food from one stage to the next too quickly. It is safer to go slow in the advancement of your textures. Some patients may take longer than others to progress from one stage to the next. If you have any concerns about being able to tolerate the next stage, consult the clinic staff.

TIMELINE DIETARY CONSISTENCY*

Day of surgery (Day 0) Water only

First Day After Surgery (Day 1) Clear fluids only

Week 1 (Days 2-7) Full fluids including SmartShape™ Shake

Week 2 (Days 8-14) Pureed foods

Week 3 (Days 15-20) Soft foods

Week 4+ (Day 21 and beyond) Solid foods

*Once you have completed current stage and are tolerating that consistency, you can progress to the next stage.

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DAY OF SURGERY

For the first 24 hours after surgery, please drink water only.

DAY 1 - CLEAR FLUIDS

START DATE: Day 1 – first day after surgery END DATE: Day 1

Clear Fluids Low-calorie, low-acid fruit juices, such as apple, grape or cranberry Decaffeinated coffee or tea Fat-free clear broth or soup Low-calorie Jell-O (avoid pre-made) Sugar-free popsicle

GOALS

• 1.5L - 2L of fluid per day • Sip fluids slowly & frequently throughout the day; aim for 30mL every 15 minutes• This volume is meant to be a guide. You will learn quickly what feels comfortable & be able to gradually increase to 60 - 80 mL per swallow during the first week after surgery.

GUIDELINES

• It is important that you drink adequate fluids after your procedure. Dehydration is a concern that can be prevented

• Continue frequently testing blood sugars

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STAGE | FULL FLUIDS (INCLUDING SMARTSHAPE SHAKES)

START DATE: Day 2 - after discharge, at home END DATE: Day 7 - the full day

t FULL FL

LIST OF ACCEPTABLE FOODS DURING THIS STAGE Food Group Examples

Vegetables and Fruit

Thinned applesauce (unsweetened) Vegetable juice (no chunks, low sodium) Low acid fruit juices such as apple, grape, cranberry (low calorie, diluted with water)

Milk & Milk Alternatives

Milk/ fortified soy beverage (skim or 1%) Classic yogurt (no chunks, low/non-fat, thinned with milk or water) Greek yogurt (non-fat, thinned with milk or water) Kefir yogurt (thinned with milk or water) Yogurt drink (low fat) SmartShape™ Shake Pudding (no chunks, made with low fat milk, thinned)

Grain Products Cream of Rice, Cream of Wheat, Oat Bran hot cereal (thinned) Fats and Oils Limit all (including butter, margarine, oil) Miscellaneous Sugar-free popsicles

GOALS

• 1.5L - 2L of fluid per day • Sip fluids slowly & frequently throughout the day; aim for 60 - 80 mL every 15 minutes • Full fluid meals should not exceed 1/2 cup (125mL)• Aim for at least 60 - 80 grams of protein per day

GUIDELINES

• It is important that you drink adequate fluids after your procedure. Dehydration is a concern that can be prevented

• Look for opportunities to choose intakes that contain protein• Consider using the SmartShape Shake as the fluid you choose to consume on 15 minute intervas

• Restart vitamin supplements (chewable / liquid); do not take on an empty stomach• Regular testing of blood sugar

MEDICATIONS

•You may resume your regular medication when you get home. Crush/open or take liquid form for the first three days post op. After three days you should be able to tolerate your medications in solid form.

•We recommend you discuss all of your current medications with your family MD/pharmacist as the absorption of certain medications may be altered post operatively due to the 'bypass' of the first 1/3 of your small intestine

•Consult with your pharmacist if you have any questions about crushing or opening medication

•Contact the nurses if you excessive pain after taking your medication•Please note if you take Wellbutrin it CANNOT be crushed

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Fat-free, low sodium clear broth Strained low fat cream soup

Beverages

Water or water with calorie-free flavouring i.e. Crystal Light Decaffeinated tea/coffee Non-carbonated, low calorie beverages

SAMPLE MENU Meal Day 1 Day 2

BREAKFAST 8am

½ cup cream of wheat made “thin” with skim milk**

½ -cup meal replacement shake

MID-MORNING 10am

½ cup meal replacement shake ½-cup unsweetened applesauce, thinned**

LUNCH 12pm

½-cup cream of potato soup – strained** ½-cup cream of mushroom soup – strained**

MID-AFTERNOON 2pm

½-cup Greek style non-fat yogurt, thinned ½-cup vanilla yogurt drink

DINNER 6pm

½-cup low-fat cream of spinach soup – strained**

½-cup low-fat cream of tomato soup – strained**

EVENING 8pm

½-cup high protein pudding, thinned** ½ -cup meal replacement shake

** OPPORTUNITY TO ADD PROTEIN POWDER (SEE PROTEIN SECTION OF THIS GUIDE)

Dehydration Assistance Tool

When you are drinking enough fluids, your body is in balance and your urine may be a pale straw yellow color. When you do not drink enough fluids, your kidneys try to save as much water as they can and cause your urine to be darker in color (more concentrated).

Dark yellow-brown urine is a sign that you are dehydrated and that you should drink more fluids to prevent dehydration. Your fluid intake goal is to make your urine, no darker than the color # 3, on the chart. The darker colors (4-8) are signs of dehydration and may cause you to become ill.

Note: Certain vitamins and medications can change your urine color. If you are concerned about hydration levels, contact your physician for follow-up.

REFERENCE: http://www.hdgh.org/uploads/BariatricAssessmentandTreatmentCentre/dehydration%20urine%20colour%20chart.pdf

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STAGE | PUREE FOODS

START DATE: Day 8 END DATE: Day 14 - the full day

You may be able to eat the same foods the rest of your family is eating by using a blender or food processor to puree it. Everything you eat at this stage must be pureed or blended (no chunks). If you eat foods that have not been pureed, it may cause an obstruction which can lead to serious complications. Initially, you may not be able to eat all of the items recommended in the meals below. Listen to your body. Start with 1 oz (2 tbsp) portions and gradually include more pureed food at each meal. You should stop eating if you feel discomfort or pressure when eating. How to Puree Your Foods Step 1 - Cut food into small pieces about the size of your thumbnail Step 2 - Use ice cube trays as a measure of 2 ounces of food Step 3 - Place food in the blender Step 4 - Add enough liquid (fat free chicken broth or fat free gravy) to cover the blades Step 5 - Blend until smooth like applesauce or baby food Step 6 - Strain out the lumps, seeds or pieces of food Step 7 - Use spices and herbs to flavor food Helpful Hints Remove seeds, skins and fat before putting food into blender Other liquid options include water, skim milk, strained low-fat soup If you have left over pureed foods, try freezing in single serving portions in ice cube trays and

put the frozen cubes into plastic freezer bags

GOALS

• 2L - 2.5L of fluid per day• Sip fluids slowly & frequently throughout the day; aim to consume fluids every 15 minutes

• Puree meals should not exceed 1 cup (250mL)• Aim for at least 60 - 80 grams of protein per day

GUIDELINES

• Progress to this stage when full fluids are going down without intolerance• Consider baby food for ease and convenience • Continue taking vitamin supplements (chewable / liquid) & frequently testing blood sugars

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Very lean and dry meats puree better by adding a small amount of ‘healthy’ fat (margarine,

oil, light mayonnaise, gravy, etc.), or small amounts of lemon juice or light mayonnaise Try pureed peas, canned beans or sweet potatoes Starches puree better when hot Rice and potatoes tend to puree into a gummy paste and are not recommended Pasta or noodles are not recommended as they are not well-tolerated Fresh vegetables are much better than canned If using canned fruit, drain first then add a few drops of lemon juice to help prevent them

from discoloring Add melted margarine or a small amount of liquid to help reach the smooth applesauce

consistency

LIST OF ACCEPTABLE FOODS DURING THIS STAGE Food Group Food Choices

Meat & Meat Alternatives

Pureed soft poached eggs or pureed scrambled eggs Blend moist meat, poultry and seafood, Silken tofu High protein meal replacement shakes Avoid: peanut or other nut butters

Vegetables & Fruits

Cooked soft or “overcooked” then blended Unsweetened applesauce Any fruit pureed without the skin (if from jar or can – don’t choose fruits in syrup) Low sodium vegetable juice Avoid: raw foods, corn, root vegetables such as white potatoes

Milk & Milk Alternatives

Low-fat or non-fat pureed cottage cheese or ricotta cheese Sugar-free custards and puddings Non-fat, unsweetened/sugar-free yogurt or frozen yogurt Avoid: Chocolate milk, sweetened condensed milk, 2% or whole milk

Grain Products

Hot cereal – unsweetened pureed oatmeal or cream of wheat (make with skim milk) Avoid: pasta, bread, rice

Fats & Oils Limit all (including butter, margarine, oil) Miscellaneous Foods

Blended soups (no chunks of vegetables/meat) – cream soups should be low-fat Egg drop or miso soup Sugar-free popsicles

Beverages

Water OR water with Crystal Light De-caffeinated coffee or tea Non-carbonated, low-calorie beverages High protein meal replacement shakes Avoid: sweetened fruit drinks, vegetable juices, sweetened iced tea, carbonated beverages/soda, caffeinated beverages and alcohol

NOTE: All food and beverages listed in the full fluid dietary stage are still considered acceptable in the puree stage. AGE

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3 DAY SAMPLE MENU

BREAKFAST 8am ½-cup cooked pureed cereal made with ½-cup skim milk

½-cup unsweetened applesauce ½-cup non-fat pureed cottage cheese

1 poached, pureed egg ¼-cup unsweetened applesauce

MID-MORNING SNACK ½ -cup meal replacement shake ½-cup meal replacement shake

½-cup pureed fruit ½-cup non-fat Greek yogurt

LUNCH 12pm ½-cup low fat yogurt ½-cup pureed fruit

½-cup blended vegetable soup ½-cup egg salad pureed

½-cup blended lentil soup ½-cup tuna salad pureed

MID-AFTERNOON SNACK ½-cup sugar free pudding make with skim milk 1 sugar free popsicle

½-cup low fat pureed cottage cheese 1 sugar free popsicle

½-cup low-fat ricotta cheese with cinnamon with ½-cup meal replacement shake

DINNER 6pm ½-cup blended chicken or bean soup ½ -cup pureed fruit

2 oz soft fish pureed ½ cup pureed peas

½-cup chicken soufflé pureed ½-cup pureed sweet potato

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STAGE | SOFT FOODS

START DATE: Day 15 END DATE: Day 20 - the full day

The soft food stage often refers to items that are easily cut or “broken” under the pressure of one’s fork; therefore, it eliminates foods that are hard to chew and swallow, including raw fruits and vegetables, chewy breads, and tough meats.

The soft food stage prepares you for solid foods. Initially, you may not be able to eat all of the items recommended in the meals below. Gradually increase your portions as the days go by. In general, you should be limited to 1side plate of food per meal. Remember to chew your food very well and eat slowly. Choose protein and fibre at each meal and snack to provide nutrition and help with satiety. The best sources of protein are lean meats, poultry, seafood, fish, eggs, dairy products, beans and lentils. Stop after the described portion and begin to check for a feeling of satiety (also referred to as the absent feeling of hunger). If you feel full, pressure or any sense of discomfort you may have eaten too much. These are signs that you are eating too quickly or your stomach is full – slow down your pace of eating or stop eating the rest of your meal to avoid feeling unwell.

GOALS

• 2.5L - 3L of fluid per day • Sip fluids slowly & frequently throughout the day; aim to consume fluids every 15 minutes

• Soft food meals should not exceed 1 small 6-8 inch diameter side plate side• Implement "20/20" and "45 seconds" rules • Aim for at least 60 - 80 grams of protein per day

GUIDELINES

• Progress to this stage when puree fluids are going down without intolerance• Continue taking vitamin supplements (chewable / liquid) & frequently testing blood sugars

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SAMPLE MENU

Meal Day 1 Day 2 BREAKFAST

8am ½-cup cooked cereal made with ½-cup skim milk ¼-cup unsweetened applesauce

1 egg 2 tbsp diced ham 1 tbsp low fat shredded cheese 1 small mashed ripe banana

MID-MORNING 10am

2 tbsp hummus ¼ small whole grain tortilla

½-cup low fat pudding ¼-cup blueberries

LUNCH 12pm

½-cup tuna salad with low-fat mayo ¼-cup low-fat yogurt ¼-cup drained canned pear

½-cup mixed bean salad ¼-cup cottage cheese 1-drained canned peach half

MID-AFTERNOON 2pm

½ cup skim milk ½ cup canned fruit

½-cup low-calorie hot chocolate made with skim milk

DINNER 6pm

3-oz steamed chicken ¼-cup boiled broccoli ¼-cup well cooked green beans

3-oz steamed salmon ¼-cup boiled cauliflower ¼-cup mashed sweet potato

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STAGE | SOLID FOODS

SmartShape™ offers detailed educational sessions via webinar to expand on the recommended nutrition regime from this point forward. To review upcoming webinars and register, visit the Events Calendar on our website. It is very important that you chew your food very well and eat very slowly. Initially, you may not be able to eat all of the items suggested in the meals below. Gradually increase your portions as the days go by. Generally, you should be limited to 6-8 inch diameter side plate of food per meal. You may not be able to eat this entire portion at one time at this stage. You can split this portion in half and eat smaller meals through the day. Additional Instructions Introduce solid foods one at a time. Limit use of butter, margarine, mayonnaise, oil, gravy, cream, jam, jelly, honey and table sugar. Bake, boil, barbecue or broil food. Remember to take your vitamin supplements. Stay well hydrated. Suggestions

First Try… Then Try… Casseroles – no hard vegetables or crunchy toppings

Tender moist meats, sliced thinly

Homemade soups or well-cooked stews Any other food not yet tried Ground meat Minced chicken/turkey Crackers

Note: Raw fruit and vegetables and sliced meats should be tried only after you are tolerating a wide variety of foods. Some individuals may find the following foods difficult to tolerate: White bread or un-toasted bread, pasta or rice Red meat such as beef or pork Dry meat, poultry or fish Skin of poultry or fish Membrane, core, seeds or skins of fruits and vegetables Fibrous vegetables (corn, celery, asparagus, pineapple) Dried fruits, nuts, popcorn or coconut Fried foods or foods high in fat Chili or other highly seasoned foods Reheated or microwaveable foods

Once you are able to tolerate a small side plate of food comfortable, aim for three balanced meals per day and avoid snacking or grazing between meals, unless meals are greater than 4 hours apart. If you are hungry between meals, choose nutrient-dense foods that contain protein and fibre.

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Potential Nutrition Complications After MGB Surgery

COMPLICATION DESCRIPTION ACTION / REMEDY Nausea, vomiting, stomach pain

May be a result of surgery itself or may be behavior induced

Do not speed up diet progression Eat slowly Chew foods thoroughly Avoid drinking large volumes at meal times Reduce portion per meal Unless otherwise indicated on prescription, take

vitamin supplements and medications after eating Consider over-the-counter products (ie. non-drowsy

Gravol, Pepto-Bismol)

Dehydration Dark urine, less urine output, dry mouth and tongue, tiredness, dizziness, lower back pain

Drink a min of 2L per day Sip constantly throughout the day; consider a 15 min

reminder routine Suck on ice chips Carry portable water bottle

Dumping syndrome / diarrhea

Soft or liquid stool Cramping, bloating, nausea, loose stool, feeling faint, increased heart rate Symptoms typically present 10 – 90 minutes after eating and can last up to 3 hours

Avoid sugars and sweets Avoid foods/fluids with “added sugar” in the first 3

ingredients on the label Choose products with less than 5g of sugar per serving Avoid fatty foods, caffeine, alcohol, spicy food Eat protein & fibre at each meal and snack Consider stool thickening foods to diet; bananas,

applesauce, legumes, or oatmeal Drink largest fluid volumes between meals Drink more water to make up for the losses

Gas Cramping, bloating, pain in lower back,

abdomen, shoulder

Avoid carbonated beverages, straws, gulping / chugging, skipping meals, chewing gum Eat slowly Chew food thoroughly Be mindful of beans, lentils, legumes, broccoli,

cauliflower Consider products such as Gas-X

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APPENDIX 1 | Pre-Op Regimen Recipes

The pre-op regimen is a challenging one! However, by varying the way you flavor and cook the low glycemic vegetables outlined in the Food Guide, as well as your shakes, you can deceive your mind and body into thinking that you are having an assortment of exquisite indulgences! Although there are pre-determined serving sizes outlined for each recipe, recall that in a single day, you are not to exceed the 250 calorie maximum for your total vegetable intake. Your serving size will look very different than what the recipe describes as a typical serving. The great thing about making extra is that leftovers can be used in the future for meals and snacks, which significantly cuts down on time spent planning and preparing food. These recipes are quick and easy, modified to make you feel satiated and will surely tantalize your taste buds. Recipes within this resource have been developed, trialed and taste-tested by your very own SmartShape™ care team!

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Chocolate & Orange Shake Cinnamon Apple Shake

INGREDIENTS 10 – 12 oz water Crushed ice 1 Chocolate SmartShape™ Shake 1 – 2 drops orange extract Blend until thick

INGREDIENTS 6 – 8 oz sugar-free apple Kool Aid® 1 Vanilla SmartShape™ Shake 3 dashes of cinnamon Blend ingredients. Serve chilled

Raspberry Dream

INGREDIENTS 10 – 12 oz water Crushed ice 1 Vanilla SmartShape™ Shake Raspberry Crystal Light Blend until thick

Mint Chocolate

INGREDIENTS 1 Chocolate SmartShape™ Shake ¼ tsp mint extract 1 packet calorie-free sweetener Blend and enjoy!

Chocolate Pudding SmartShape™ Shake Iced Tea INGREDIENTS 2 ice cubes, crushed 6 – 8 oz water 1 Chocolate SmartShape™ Shake Blend until thick

INGREDIENTS 6 oz cold sugar-free iced tea ½ tsp lemon juice 1 Vanilla SmartShape™ Shake Ice cubes to taste Whip in blender until frothy

Spiced SmartShape™ Shake INGREDIENTS ¾ - 1 ¼ cup cold water Spice, as desired (see chart) 1 SmartShape™ Shake packet, any flavor Pour cold water into shaker or blender. Add spice and SmartShape™ Shake packet. Shake or blend until dissolved. Serve over ice.

Spice Vanilla Shake Chocolate Shake

Allspice pinch

Cinnamon pinch 1/8 tsp

Cloves pinch pinch

Ginger 1/8 tsp 1/8 tsp

Nutmeg 1/8 tsp 1/8 tsp

Recipe reference: Nestle Healthcare Nutrition Inc.

Scrumptious SmartShape™ Shake Recipes | PRE-OP

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Recipe reference: kitchenparade.com

Recipe reference: kitchenparade.com

Lemon Asparagus INGREDIENTS DIRECTIONS 1 pound asparagus Remove the lower half of asparagus spears and discard. 2 -4 tbsp lemon juice Place in vertical steamer over boiling water for 5 – 8 minutes. Pepper to taste Transfer to serving dish, toss with lemon juice and pepper. SERVING: 4

Recipe reference: kitchenparade.com

Roasted Cauliflower INGREDIENTS DIRECTIONS 4 cloves garlic, minced Set oven to 425˚F. ¼ tsp pepper Stir together all ingredients in a large bowl until cauliflower is uniformly coated. ½ tsp paprika Transfer to baking sheet in single layer (use a second sheet if needed). 1 head cauliflower, cut in small florets Roast for 30 – 45 minutes, stirring every 5 minutes for last 15 minutes. SERVING: 4

Recipe reference: kitchenparade.com

Curried Zucchini INGREDIENTS DIRECTIONS 1 tbsp garlic, minced Arrange zucchini in a single layer and sauté with water on medium heat. ½ - ¾ tsp curry powder Add garlic and curry. Cover and let simmer for approximately 10 – 15 min. 1 pound zucchini, peeled, sliced in half-in diagonals Add pepper and cilantro. Pepper to taste Cilantro, chopped SERVING: 2

Caraway Cabbage INGREDIENTS DIRECTIONS 1 small head green cabbage, finely sliced Steam or sauté cabbage in water. Turning occasionally, until limp but not brown. ¼ cup water Add remaining ingredients except parsley. 1 tsp pepper Cover for 30 minutes. 1 – 1 ½ tbsp caraway seeds Squeeze lemon juice on top, garnish with parsley for color and serve warm. 1 tsp onion powder 2 tbsp sucralose (Splenda®) Parsley, chopped fine (optional) ½ lemon (optional) SERVING: 6

Fresh Recipes & Beverages | PRE-OP

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Recipe reference: about.com

BBQ Grilled Vegetables in Foil INGREDIENTS DIRECTIONS GARLIC-GINGER VINAIGRETTE DRESSING Preheat grill. ½ tbsp garlic Whisk vinaigrette ingredients in a large bowl. ½ tbsp fresh ginger (or ½ tsp ground ginger) Wash and drain vegetables then slice. Fresh ground pepper Add vegetables to vinaigrette, tossing to coat. ½ cup vinegar Tear two foil sheets about 11 x 18. Divide vegetables between the sheets; fold to create a pouch and seal tightly. VEGGIES Place on grill rack for 20 – 25 minutes until vegetables are cooked. 2 ribs celery, de-veined, 1” pieces cut on a diagonal 8 brussel sprouts, cut into half 8 white mushrooms, sliced ½ head cauliflower (cut into florets) ½ head broccoli, discard stem, cut top of broccoli into florets ¼ head red cabbage, cut in small wedges SERVING: 5

Recipe reference: kitchenparade.com

Sublime Vegetable Stock INGREDIENTS DIRECTIONS ½ cup white mushrooms, chopped Oven roast or brown in a non-stick pan with no additives other than water ½ cup celery (including leaves), chopped and your selection of low GI vegetables for about 5 – 7 min. Stir quickly. ½ cup zucchini, chopped Put vegetables in a pot and cover with water. ½ cup asparagus, chopped Bring water to a boil, then reduce heat and let simmer for 30 – 60 min until ¼ broccoli (including stems)** vegetables are soft. ¼ cauliflower, chopped** Drain liquid through a strainer or cheese cloth. ¼ kale, chopped** Cool liquid in refrigerator overnight. 4 garlic cloves, minced Storage options: 1 tsp thyme 1. Store in refrigerator and use within a few days. 1 tsp parsley 2. Freeze in cup size containers. 1 bay leaf 3. Freeze in Ziploc bags. Pepper and any other additional seasonings to taste 4. Pour stock into ice cube trays. **can dominate flavor TIP This can be used as a base for vegetable soup or as a cooking liquid for other

recipes to add flavor while avoiding the addition of fats.

Staff Recipe

Pickled Mushrooms INGREDIENTS DIRECTIONS 1 pound small fresh white mushrooms Wash mushrooms well. Trim and set aside. 1 garlic clove, minced Combine all remaining ingredients in a large saucepan. Bring to a boil. 1 tsp onion powder Add mushrooms. Boil for 8 – 10 min or until mushrooms are just tender. ½ cup fresh parsley, chopped Chill mushrooms in liquid for at least 2 hours. Drain before serving. 1 bay leaf ½ tsp dried thyme 2 cups white vinegar 3 tbsp lemon juice SERVING: 4 - 6

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Recipe reference: lpl.arizona.edu

Recipe reference: squidoo.com

Stuffed Mushrooms INGREDIENTS DIRECTIONS 4 large Portobello mushroom caps Wash mushrooms carefully and cut off stems. Dice and set aside. 1 cup white vinegar Stir together white vinegar, garlic powder and onion powder until blended. ½ tsp garlic powder Place mushroom caps into a large re-sealable plastic bag. ½ tsp onion powder Pour in vinegar mixture, seal bag and turn gently to coat mushrooms evenly. 2 cups fresh spinach, chopped Place in refrigerator for 1 hour. Pepper and other seasonings to taste Pre-heat oven to 400˚F. Remove mushrooms for marinade. Shake off excess and discard marinade. Place mushrooms on baking sheet. Bake for about 15 min until liquid runs out and mushrooms are browned and have shrunken to about half their original size. In a frying pan over medium heat, sauté the diced mushroom stems with the spinach and seasoning. Add the liquid from the mushroom pan to your skillet until the spinach is soft/wilted. SERVING: 4

Staff Recipe

Cucumber & Dill Salad INGREDIENTS DIRECTIONS 1 seedless European cucumber or 2 American cucumbers Wash the cucumbers and partially remove the peel in lengthwise 3 tbsp white vinegar strips using a vegetable peeler and leaving a little skin between 1 tbsp sucralose (Splenda®) each strip. Fresh ground black pepper Thinly slice the cucumber widthwise. 1 small red onion, sliced and broken into rings Place the vinegar, sucralose and pepper in a bowl and whisk until 3 tbsp fresh dill, chopped the sucralose is dissolved. Add the cucumber, onion and dill. Toss well. SERVING: 4 TIP

The salad can be served immediately, but it will improve the flavor if you let the ingredients marinate for approximately 5 min.

Kale INGREDIENTS DIRECTIONS 2 bunches kale Rinse kale well and place in a large bowl of cold water. ½ cup water Drain and cut off the tough stems. Cut leaves into ¼ inch strips. ¼ cup vinegar In a wok or large frying pan, heat water and vinegar over moderate to high heat. Add 4 cloves garlic, finely chopped the garlic and cook. Stir every 30 seconds. ½ tsp fresh ground black pepper Add the greens and cook. Stir until they begin to wilt and turn bright green. 1 tbsp lemon juice Stir constantly for approximately 8 minutes. Crushed red pepper to taste (optional) Season with pepper, lemon juice and crushed red pepper. SERVING: 8

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Recipe reference: allrecipes.com Thirst Quencher Ginger Lemonade INGREDIENTS DIRECTIONS 1.5 cups sucralose (Splenda®) In a saucepan, combine sucralose, water & ginger. 2 L water Heat to a boil and stir occasionally. 7 slices ginger root Remove from heat and stir in lemon juice. 1 tsp ground ginger Cool for 15 minutes then refrigerate for approximately 1 hour or until chilled. 2 cups fresh lemon juice Serve over ice and garnish with lemon slices. 2 lemons, sliced TIPS If you pour some of the ginger lemonade into an ice cube tray and freeze it, you can keep your beverages chilled without diluting the flavor! SERVING: 10

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Dressings | Vegetable Dips | Marinades – PRE OP

Spicy Mustard Mayhem

Eureka Paprika

Citrus Surprise

Mediterranean Madness

INGREDIENTS DIRECTIONS ¼ cup brown mustard seeds Combine all ingredients into a blender/food processor on high speed until liquefied. ¼ cup yellow mustard seeds Do not fret if your device cannot crush the seeds and/or blend the garlic. Pour into 1 cup white vinegar a storage container and refrigerate until thickened slightly. The longer it sits, the more 1 tsp sucralose (Splenda®) flavor comes out! Stir or shake before using. 1 tsp red pepper flakes 1 – 2 cloves garlic TIPS

#1 Remove the red pepper flakes to create a less spicy version. #2 Use a mortar & pestle to crush the mustard seeds to create more of a paste. #3 If you consider yourself a “texture person” and the solid mustard seeds turns you off, try consuming this dressing/dip with solid, crunchy veggies such as broccoli and cauliflower to mask the crunchiness of the mustard seeds.

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup lemon juice liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tsp sucralose (Splenda®) container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp dried onion powder Stir or shake before using. 1 tsp pepper 1 tsp paprika 1 – 2 cloves garlic

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup water liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tbsp lemon juice container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp dried onion powder Stir or shake before using! 1 tsp pepper 1 tsp oregano 1 tsp basil 1 – 2 cloves garlic

INGREDIENTS DIRECTIONS ½ cup white vinegar Combine all ingredients into a blender/food processor on high speed until ½ cup lemon liquefied. Do not fret if your device cannot blend the garlic. Pour into a storage 1 tbsp orange grind container and refrigerate until cool. The longer it sits, the more flavor comes out! 1 tsp sucralose (Splenda®) Stir or shake before using! 1 – 2 cloves garlic

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Allspice Cinnamon; cassia; dash of nutmeg or mace; dash of cloves Aniseed Fennel seed or a few drops of anise extract Cardamom Ginger Chili Powder Dash bottled hot pepper sauce plus a combination of oregano & cumin Cinnamon Nutmeg or allspice (use only ¼ of the amount) Cloves Allspice; cinnamon; nutmeg Cumin Chili powder Ginger Allspice; cinnamon; mace; nutmeg Mace Allspice; cinnamon; ginger; nutmeg Nutmeg Cinnamon; ginger; mace Saffron Dash turmeric (for color)

Basil Oregano or thyme Chervil Tarragon or parsley Cilantro Parsley Italian Seasoning Blend of any these: basil, oregano, rosemary and ground red pepper Marjoram Basil; thyme; savory Mint Basil; marjoram; rosemary Oregano Thyme or basil Parsley Chervil or oregano Red Pepper Dash bottled hot pepper sauce or black pepper Rosemary Thyme; tarragon; savory Sage Poultry seasoning; savory; marjoram; rosemary Savory Thyme; marjoram; sage Tarragon Chervil; dash fennel seed; dash aniseed Thyme Basil; marjoram; oregano; savory

Spice & Herb Substitution Chart

Spice Substitutions

Herb Substitutions

Reference: http://homecooking.about.com/library/weekly/blherbsub.htm

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Favorite Flavor Combinations

Pesto Gingery Garlic Spicy Garlic

¼ cup basil, chopped 1 clove garlic, chopped Pinch ground black pepper

1 tsp ginger, grated 1 clove garlic, chopped ¼ tsp lime zest (grated lime peel)

1 tsp red pepper flakes 1 tsp ginger, grated 1 clove garlic, chopped

Garlic n Herb Tikka Masala Spiced Curry

Chili & Lime

2 tbsp fresh parsley, thyme, rosemary, chopped 1 clove garlic, chopped

2 tbsp cilantro, chopped 1 tsp lemon juice ½ tsp garam masala ¼ tsp smoked paprika 1 clove garlic, chopped

2 tbsp cilantro, chopped 1 tsp curry powder 1 tsp lime juice ¼ tsp lime peel, grated Pinch ground cayenne

¼ tsp lime zest 1 tbsp lime juice 2 tbsp chili powder

Reference: http://www.becel.ca/en/becel/HeartHealthyRecipes/Condiments-and-Spreads/Corn-on-the-cob-topping-twisters.aspx

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APPENDIX 2 | Post-Op Regimen Recipes

The full fluid stage is one exciting step closer to getting back to normal consistencies and intake routines. However, it still demands attention to texture and nutrient density. Below are a few smoothie recipes that do not include the SmartShape Shake to help change up the taste profile you are experiencing. These recipes are meant to increase the quality of your overall nutrition with special attention to protein levels for the purpose of satiety and assisting the body through the healing process. Please note that the volume produced by each of the recipes is not meant to be consumed in one sitting, so feel free to store it in the fridge and sip on it throughout the day or even the next day at your leisure. Remember to avoid the use of a straw, sip slowly from a glass, and pace yourself while being mindful of any intolerance or discomfort that you may or may not experience.

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*It is incredibly important that flaxseeds are ground to a very fine texture similar to that of sand. You may purchase already ground flaxseeds at your local supermarket, or you can choose to grind whole flaxseeds yourself. If you select the latter option, pour the flaxseeds into a coffee grinder and adjust the setting to the finest grind. Allow the grinder to run for about 20 seconds. To increase the shelf life, store them in an airtight opaque container in the fridge.

Scrumptious SmartShape™ Shake Recipes | POST-OP

Tropical Temptation INGREDIENTS DIRECTIONS ½ cup (125mL) of skim milk, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1/3 cup (100g) of vanilla yogurt, 0% fat Strain and enjoy! 1 cup (165g) fresh mango chunks ½ cup (82.5g) fresh pineapple chunks ½ banana (62g), mashed ½ cup (125mL) cranberry juice 1 tsp (5 mL) honey ½ cup (125g) ice NUTRITION QUICK FACTS: Calories - 356 kcal | Protein - 10.99 grams | Fibre - 5.3 grams

Lean & Green INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla Greek yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 cup (67g) fresh spinach Strain and enjoy! 2 cups (340g) honeydew melon, peeled, deseeded, chopped 1 small (148g) fresh pear, peeled, chopped 1 tbsp (30mL) frozen orange juice 2 tsp (10mL) honey 1 tbsp (14g) extra-fine ground flax seeds* ½ cup (125g) ice NUTRITION QUICK FACTS: Calories - 408 kcal | Protein – 14.88 grams | Fibre – 9.9 grams

Tangy Delight INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla Greek yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 cup (189g) canned oranges, strained Strain and enjoy! 1/3 cup (82g) pineapple 2 tbsp (60mL) frozen orange juice ¼ tsp (1.25mL) vanilla extract 2 tbsp (14g) extra-fine ground flax seeds* ½ cup (125g) ice NUTRITION QUICK FACTS: Calories – 388.2 kcal | Protein – 14.8 grams | Fibre – 7 grams

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TIPS & TRICKS

FLAVOR – If you find the flavor of any of the smoothies to be overwhelming, you can always add more water or ice, to increase the dilution factor.

PROTEIN – To increase the protein content in your smoothies, you can substitute Greek yogurt, or select a high a protein powder additive. See NUTRITION section of this guide for more information.

BLENDING – Sometimes you may find that not all the ingredients have been blended thoroughly, so it is mentioned that each smoothie must be strained before consumption. To prevent waste, ensure to blend for at least 25 seconds and consider re-blending the items left behind in your strainer.

FREEZING – Sometimes storing your excess smoothie in the fridge can cause separation and taste changes over time. A good alternative is it to freeze them instead. A great way to preserve your smoothie’s flavor and texture is to turn it into popsicles! Simply pour the smoothie into popsicle molds and freeze for about 5 hours. You can also freeze them in ice trays and thaw out however, many cubes as you would like.

SMOOTHIES THAT SIT – It isn’t uncommon to have separation of ingredients when smoothies are left sitting in the fridge. If you encounter this challenge, make sure to shake your smoothie vigorously before consumption. Also, consider pouring half your smoothie into an ice cube tray so that future shakes can avoid dilution but are still kept cold!

INGREDIENTS DIRECTIONS 1/3 cup (100g) vanilla yogurt, 0% fat Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1 medium peach (150g) , peeled, cored and Strain and enjoy! cut into halves 1 cup (152g) fresh strawberries, sliced 1/3 cup (41g) raspberries, fresh or frozen 1 tbsp (14g) extra-fine ground flax seeds* 1 ½ tsp (7.5mL) honey 1.2 cup (125g) ice NUTRITION QUICK FACTS: Calories - 292 kcal | Protein – 8.58 grams | Fibre – 8.8 grams

Dairy-Free Berry Blast INGREDIENTS DIRECTIONS 1/3 cup (41g) raspberries, fresh or frozen Combine all ingredients in a blender & blend until smooth for approximately 25 sec. 1/3 cup (49g) blueberries, fresh or frozen Strain and enjoy! 1/3 cup (48g) blackberries, fresh or frozen ½ cup (77g) cherries, without pits ½ banana(62g), mashed 1 tbsp (30mL) frozen orange juice ½ cup (125mL) fortified vanilla soymilk 1 tsp (5mL) honey ½ cup (125mL) decaf earl grey tea, steep 1 bag NUTRITION QUICK FACTS: Calories - 304 kcal | Protein – 6.32 grams | Fibre – 9.7 grams

Peachberry Pleasure

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INGREDIENTS DIRECTIONS 1 12oz. box of firm silken tofu Add all ingredients in a blender and blend until smooth. Place in refrigerator until ¼ cup cocoa powder thickened. Keep covered in fridge until ready to eat. 2-3 tbsp (or to taste) sweetener of choice 1 tbsp milk (1% or almond/soy/ rice milk) 1 tsp vanilla extract ½ ground instant coffee ½ tsp salt

Chocolate Protein Pudding

Spiced Squash INGREDIENTS DIRECTIONS 1 butternut squash Preheat oven to 400F. Roast butternut squash until soft for approximately 45 minutes. ½ tsp vanilla extract Add all ingredients to blender and blend until smooth. 1 tsp maple extract 1 tsp cinnamon ¼ tsp nutmeg ¼ tsp ginger ¼ tsp salt

Roasted Mushroom & White Beans INGREDIENTS DIRECTIONS 1 can white kidney beans (Cannellini) Preheat oven to 350F. Roast mushrooms in oven until soft and dark (15 mins). Sautee 8oz. Cremini mushrooms onions and garlic until tender and translucent. Add all ingredients into a blender and 1 tsp minced garlic blend until smooth. 1/3 cup chopped onion 1 tsp black pepper 1 tbsp lemon juice 1 tsp finely chopped fresh thyme 1 tbsp olive oil

Delicious Puree Recipes | POST-OP

INGREDIENTS DIRECTIONS 3-4 potatoes or sweet potatoes, peeled/mashed Add white beans, onion, garlic & broth to blender or food processor. ½ can white beans, drained/rinsed Puree until thin (no clumps). Mix into mash potatoes. ¼ cup broth (vegetable, chicken or beef) Add skim or 1% milk, if needed. ½ small onion, chopped ½ tsp garlic powder (or 1 tsp minced garlic)

High Protein Mashed Potatoes

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Reference: Ottawa Hospital and University Health Network (UHN)

Savoury Beef Puree INGREDIENTS DIRECTIONS ½ pound (225g) boneless lean beef (cut into 1 inch cubes) Place meat & water in a saucepan. Bring to a boil. 1 cup water or broth Reduce heat & simmer for 30 min. or until meat is tender. Salt & pepper to taste Remove from heat and let cool. Refrigerate until chlled. Blend or puree meat with broth until smooth. TIPS Season with salt & pepper. To improve the color, add a tbsp. of tomato sauce or Pour into containers. Cover, label & freeze. a tsp of tomato paste while blending.

Perfect Poultry Puree INGREDIENTS DIRECTIONS 1 pound (500g) chicken or turkey pieces (bone in, skin on) Place chicken or turkey pieces in a saucepan with water. 2 cups water or broth Bring to a boil then reduce heat. Simmer for 45 min. or until meat ½ tsp thyme or sage separates easily from the bone. Salt & pepper to taste Remove from heat. Let cool. Reserve the cooking liquid. Remove from skin, fat and bones. Cut meat into small pieces. Puree meat with some of the cooking liquid, salt, pepper & thyme. Pour into containers. Cover, label & freeze.

Power Packed Legume Puree INGREDIENTS DIRECTIONS 1 cup (250mL) dried legumes In a medium saucepan combine legumes & 3 cups of water . 8 cups water or broth Bring to a boil over medium heat. Boil gently for 2 min. or soak overnight. ½ tsp cumin or curry powder Remove from heat and let stand for 1 hour. Skip this step if you are making lentils. Salt & pepper to taste Drain legumes. Add 5 cups of water and bring to a boil. Reduce heat. Simmer for 40 – 60 min. Remove from heat and blend with ¾ cup cooking liquid or vegetable broth. Season with salt, pepper and a pinch of cumin or curry powder. Pour into containers. Cover, label & freeze. TIP Canned legumes are already cooked. Just rinse and puree with a little broth or vegetable juice.

Herb & Cheese Mashed Cauliflower INGREDIENTS DIRECTIONS 1 ½ cups cauliflower florets Steam cauliflower for about 10-15 min. until very tender. ½ can white beans, drained, rinsed Add cauliflower to remaining ingredients in a food processor or blender. ¼ cup skim or 1% milk Puree until smooth (no clumps). 2 tbsp low-fat or light herb & garlic cream cheese 1-2 tbsp finely chopped green onion 1 tbsp parsley (fresh or dried) 2 tsp margarine Salt & pepper to taste