dr. carlos altamirano [email protected] bariatric

Dr. Carlos Altamirano [email protected] Bariatric World & Wellness Center

Av Lerdo de Tejada Tijuana, Baja California 22000 Mexico



Preface

Hello family, the intention of this manual is to make your experience as seamlessly and successful as

possible. Here you will find the basics to have a safe weight loss surgery and improve your quality of life

before and after surgery.

The “Iron Sleever Program” is a whole system, not just the surgery. Weight loss surgery is a really simple

but powerful tool, and as such, NEEDS TO BE USED FOR IT TO WORK!! I made the “Dr Altamirano’s Irons

Sleevers Family” because I understand that the surgery by itself is not enough, that we need to treat this

problem as AN ADDICTION because IT IS! We have emotional eaters, stress eaters and I like my patients

to get advice, tips and tricks and recipes from people who actually understand your struggles, and I also

do the LIVE BROADCAST on Saturdays in order to teach people how to live a healthier life and answer

their questions. The medical follow up is the final piece that is really important to make the best out of

your process and keep your tool working at 100%.

I want to thank all of my patients for their support and recommendations and want to let all of you know

that you’re an inspiration and the reason I try to be a better version of myself every day. I’ll try to repay

you with the best service I can possibly give and will keep learning from you every day as I always do since

you’re the best teachers I have. Please DO YOUR BEST EVERY DAY, I KNOW I WILL. LET’S WORK

TOGETHER TO HAVE AN EASY, SAFE AND SUCCESSFUL SURGERY!



Important Links

Website: www.doctoraltamirano.com

Supplements Store: https://blifestyle.store/

Support group on Facebook: https://www.facebook.com/groups/214029598937524/

Facebook https://www.facebook.com/carlos.a.cano.372

Sleeve Gastrectomy LIVE! http://doctoraltamirano.com/vsg-live.html

Instagram dr_altamirano_wls_tijuana

YouTube Channel: https://www.youtube.com/channel/UCgUPpV3a81StYMnhp6gLiuQ

Fan Page on Facebook: https://www.facebook.com/drcarlosaltamirano/

LinkedIn: https://mx.linkedin.com/in/drcarlosaltamirano

http://www.doctoraltamirano.com/

http://www.doctoraltamirano.com/

https://blifestyle.store/

https://www.facebook.com/groups/214029598937524/

https://www.facebook.com/groups/214029598937524/

https://www.facebook.com/carlos.a.cano.372

https://www.facebook.com/carlos.a.cano.372

http://doctoraltamirano.com/vsg-live.html




https://www.youtube.com/channel/UCgUPpV3a81StYMnhp6gLiuQ

https://www.youtube.com/channel/UCgUPpV3a81StYMnhp6gLiuQ

https://www.facebook.com/drcarlosaltamirano/

https://www.facebook.com/drcarlosaltamirano/

https://mx.linkedin.com/in/drcarlosaltamirano

https://mx.linkedin.com/in/drcarlosaltamirano



INDEX

The Pre-Op Diet ............................................................................................................................................. 5

What to Bring with You ................................................................................................................................. 7

Surgery Day ................................................................................................................................................... 9

Post-Surgery Care ........................................................................................................................................ 13

Long Term Diet Requirements .................................................................................................................... 15

Post Surgery Nutrition ................................................................................................................................. 15

Sugested Recipes ......................................................................................................................................... 23

Medical Follow Up with Your Primary Care Physician…………………………………………………………………………….23



The Pre-Op Diet

The Pre-Op diet is necessary to shrink the liver prior to surgery. A smaller liver can reduce the need for a

5th incision (around 15% of people can have surgery with 4 incisions) and further reduce the potential for

complications.

The time you’ll need to follow the Pre-Op diet depends on your initial BMI and goes like this:

<35= 3 Days

35-40= 7 Days

40-50= 14 days

50-58= 30 days

>58= Weekly consult and one on one service to decrease potential risks*

* Patients with high BMI and/or other medical conditions may be prescribed other dietary prerequisites in addition to the

above pre-op diet.

It is not necessary to begin the diet before the time period above, however a healthy diet following the

Long-Term Diet Requirements page will help with weight loss and reduce your BMI further prior to

surgery.

To follow the Pre-Op diet properly we need to define some concepts:

Green Salad: Salad made with JUST GREEN LEAVES, EDAMAME OR GREEN BEANS, no other veggies

allowed on this phase.

Lean Protein Options (you can use some low sodium spices or condiments that ARE NOT DERIVATES OF

CORN SYRUP SUCH AS KETCHUP AND OTHER SAUCES):

Chicken Breast 4oz

Turkey 4oz

Tuna 3oz

Shrimp (Mid-Size and Boiled) 4 pieces

Egg Whites 4 pieces

Protein Shakes: Use any prepared, canned, or powdered protein drink made of whey protein preferably,

or use different kinds depending on preference and tolerance like pea, soy, rice, veggie or even meat

protein (you will find options on GNC, Vitamin shop, vitamin world, Nutrition Zone or Costco). Please be

sure it contains at least 20 grams of protein per serving and NO CARBS.



Meal plan:

Please remember this is a special diet made to detoxify your body, and even though I understand it might

sound plain and boring, YOU’RE ON A TREATMENT FOR FOOD ADDICTION, so consider this as part of a

program designed to help you achieve your goals!

• Meal 1 (8am): Green Salad with olive oil (one tablespoon), vinegar or lemon and ¼ Avocado and one

portion of lean Protein.

• Meal 2 (11am): 1 Protein Shake and 10 RAW almonds (not salty or smoked)

• Meal 3 (2pm): Green Salad with olive oil (one tablespoon), vinegar or lemon and ¼ Avocado and one

portion of lean Protein (yes AGAIN, I KNOW!).

• Meal 4 (5pm): 1 Protein Shake

• Meal 5 (9pm): Green Salad with lean Protein.

• Meal 6 FOR PATIENTS WITH BMI 50+ (11PM): One protein shake. This 6th meal can be used at your

convenience anytime depending on how you feel and how hungry you are on your day. You can use

it as a “rescue meal” when you’re feeling headaches, gastritis or real hunger.

Prior to Surgery: • Do not smoke for at least 1 month before surgery. I’m DEADLY SERIOUS, this can be life threatening

since all the irritation in your lungs can cause a clotting of the oxygen tube with tick mucus, please

take this seriously. Nicotine is not even the issue here, so gum or patches are allowed (but not vapes).

• Drink at least 100 oz. of water each day to hydrate, and ideally 1 ounce per 2 lbs. of body weight, so

150 ounces if you weigh +300 lbs. Flying and surgery will dehydrate you so It is better to show up extra

hydrated than to try to make it up after surgery. This will prevent the post-op nausea, will decrease

the need for meds and will speed your recovery A LOT.

• Discontinue vitamins, Ibuprofen, Motrin, Advil, Nuprin, Aleve or any other nonsteroidal

antiinflammatory (NSAID) medication 2 weeks prior to surgery, and Blood thinners like Levonox or

Xarelto 5 days before (or what your doctor in the US recommends). This includes baby aspirin which

needs to be discontinued 4 weeks before surgery. These medications can cause unnecessary bleeding

during and after surgery (If you are not sure, please check with the doctor). For headache or minor

pain, you may use Tylenol. Do not take any herbal medications/ remedies.

Last meal can be until midnight the night before your surgery. Consume no food after this time. Clear liquids may be consumed abundantly until 9 AM Pacific Time the day of surgery.



What to Bring with You

The hospital will provide a gown, bedding, and a towel for you. Your guest should bring their own towel.

Clothing (plan for the season)

• Yoga pants, sweatpants, shorts w/ elastic waist

• Maxi dresses, skirts

• Comfy undies and socks

• Sports bra, tank tops, and/or T-shirts

• Jacket or sweatshirt

• Comfortable shoes

• Slippers or flip-flops for walking the hall

• PJs

• You may want a robe, shawl, or poncho to cover your back side while walking the hall in your gown

Toiletries

• Shampoo & conditioner

• Body wash and/or soap, face wash

• Body lotion, face lotion (Tijuana is dry)

• Antibacterial hand cleaner (available in hospital room)

• Comb, brush, gel, hairspray, blow dryer (available in hotel room)

• Toothbrush & toothpaste

• Deodorant

• Razor, shaving cream

• Washcloth (not supplied by hospital or hotel)

• Chap stick

• You will have adhesive on your chest and stomach. Bring alcohol pads or a little oil to remove the

adhesive easily.

Other Things

• HEATHING PAD (helps with the gas pain)

• Books

• Movies



Electronics

• Cell phone

• Tablet or computer

• Chargers

• Extension Cord (6’ is enough) • The hospital and hotel have Wi-Fi.

Medication

• Bring ALL your prescribed medications (whether you are currently taking them or not) in properly

labeled pharmaceutical bottles for documentation during Pre-Op testing.

• Feminine products if menstruating

Money

• Be sure to call your Bank to let them know you are traveling to Mexico in case you use your credit

card.

• For food in the hotel and on the trip home

• Souvenirs

• Small bills for tips (driver, hospital staff, wait staff, hotel housecleaning, etc. as you see fit, NOT

MANDATORY)

Helpful travel tip: Coffee shops in the area and airports will usually provide hot water for free. Bring your

favorite tea bags or some bouillon cubes to help get your fluids in and much as possible.



Surgery Day

1. Only clear liquids (water, Gatorade, flavored water) after midnight and up until 9 AM Pacific Time.

2. Arrive at the San Diego’s or Tijuana’s airport between 7am and 12pm. You may bring one guest

who can stay with you in the hospital and hotel at no additional charge.

3. The Driver will pick you up from the airport. He will discuss when and where when he calls you

before your trip and he’ll be in constant communication with you on the phone.

4. Dr Altamirano’s assistant will meet you at the hospital and take you to get your blood drawn and

get you settled in your room.

5. You will change into your gown, get your hospital ID bracelet, your IV will be inserted and an EKG

performed.

6. You will be asked many health questions by multiple doctors, and Dr. A will talk to you, too.

7. Then you wait for transport by hospital staff to surgery.

The Surgery

1. Staff will arrive to wheel you to surgery. USE THE BATHROOM BEFORE YOU GO.

2. You will go downstairs and switch to another gurney.

3. You will wait in a staging room while any final operating room preparation is completed.

4. You will be wheeled into surgery and moved onto the table.

5. Dr. A will talk to you as you are given the anesthesia and fall asleep. Surgery usually lasts 15-30

minutes.



Right After Surgery

1. You will wake up in the staging room again. It is normal to be disoriented and nauseated from the anesthesia and feel oppression on your chest for some time.

2. You will wait here until the staff are certain you are ready to return to your room.

3. You will be wheeled to your room (and switch gurneys a few times on the way).

4. You can begin walking as soon as you are ready. During surgery, the abdomen is filled with gas to

provide space to operate. You must absorb this gas and pass it out. Walking will speed this

process and help tremendously with the gas pains. Walk as often as possible.

The Day After Surgery

1. You will perform the leak test in the morning and you will begin to drink fluids.

2. Walk, walk, walk, walk, walk! Try to sleep whenever you can to encourage healing.

3. You can take a shower today, and they may remove your IV this day or the next day.

Two Days After Surgery

1. You will be moved to the hotel midday. Dr A’s assistant will check you in and give you your key.

2. Try to drink at least 64 ounces of water/broth/decaf tea today.

3. Walk, walk, walk, walk! There is a mall across the street if you want somewhere close to explore.

The following day you will be picked up and taken back to the airport.

Do NOT take any medications after surgery until you have consulted with the doctor and gotten approval. Do NOT smoke after surgery. Smoking will dramatically slow your healing and can lead to a leak or

infection.



Post-Surgery Care

1. Take deep breaths for 15 minutes every hour the first 2 days to prevent atelectasis (respiratory

problems that can lead to pneumonia).

2. Wash your wound daily with soap and water for 1 week:

• You may feel a lump under the wounds, this is normal, as long as there is not any redness, heat, or

leakage from the incisions.

• Your wounds should heal nicely without special care; it is OK to get them wet in the shower, but

do not to soak (tub, swimming pool, hot tub) for 4 weeks.

• Signs of an infection in the wound are: redness, increasing tenderness, or thick white leaking from

the wound and you may feel a fever. However, most times is just liquified fat that we call a

SEROMA, so please send Dr A pictures of your wounds before freaking out!

3. Avoid dehydration! Take liquids every 15 minutes the first week (4 oz. every 15-20minutes; 64+ oz.

daily AT LEAST).

• Signs and symptoms of dehydration: thirst, mouth dry, concentrated/darker urine, lightheaded, dizziness, blurry sight, headache, palpitations, rapid breathing, faint.

Activity Restrictions

1. You must rest at least for a week (2 weeks are recommended). Be kind to your body and let it heal

with minimal stress and lots of sleep.

2. You can start walking 2 weeks after surgery with a heart rate goal of 110 BPM for 30mins on that HR.

Speed and distance are not the goals, the 110 BPM for 30 mins is.

3. Limit lifting for 6 weeks after surgery. No heavy lifting greater than 15 pounds for 2 weeks, then no

more than 30 pounds for 4 more weeks.

4. After 6 weeks, exercise 5 days per week. You SHOULD GO TO THE GYM or start real exercise like

swimming or cross fit, including cardio (as mentioned above in point No 2).



Take these medicines as directed (provided to you at the hospital):

• Sublingual Ketorolac (Toradol) tablets 30 mg (For pain)

• Place a tablet under the tongue up to 3 times a day as needed for pain.

• Cephalexin capsules 500 mg (antibiotic for patients that can take penicillin)

• Take 1 capsule 3 times a day for 7 days.

• Levofloxacin tablets 500 mg (antibiotic for patients allergic to penicillin)

• Take 1 tablet a day for 7 days.

• Magaldrate/Dimethicone (Gaviscon or Maalox) oral suspension

• Take 10cc 4 times a day for 3 months

• *Omeprazole capsules 20mg (gastric protector)

• Take 2 capsules (40mg) twice a day for 3 months



Long Term Diet Requirements

Your choices after surgery will determine your success in meeting your goals. Following these

recommendations will help you reach your goals in the quickest time possible. If you are not willing to

make these changes, please reconsider having surgery. Surgery will not solve food dependence,

emotional eating, or eating disorders. Please seek a therapist to address these issues before surgery.

Avoid the following from your diet (doesn’t mean “Won’t have them ever again”):

• Alcohol

• Carbonated beverages and sodas (even “diet” or “zero”)

• Artificial sweeteners (Splenda, equal, sweet & low)

• Sugar, honey, sweet foods, high fructose corn syrup

• Grains and cereals (all kinds): food products made with flour – bread, pancakes, waffles, pasta,

muffins, cereals, tortillas, breaded food, cookies, cakes, pretzels, oatmeal, crackers, rice, etc.

• Corn and corn products: popcorn, grits, polenta, etc.

• All sorts of processed foods: canned, frozen, packaged

• Starchy vegetables: (Potatoes, sweet potatoes, beets, squash, zucchini, carrots, peas)

• Legumes (beans, lentils, garbanzos, etc.)

• Fruit (except berries, cherries, strawberries, apples and grapefruit)

• Fruit juices (even if they are natural or homemade, this are considered concentrated sugar)

• Vegetable oil (canola, corn, soy)

• Margarine or pam (cooking sprays)

• Foods that say “low-fat”, “low-calorie”, “low-sugar” etc.



Your new preferred diet should include:

• Eat every 3 to 4 hours (set a timer if necessary)

• Stay well hydrated (drink water or infused water all throughout the day)

• Your choices of protein should be Chicken, beef, poultry, lean pork, fish, eggs, low/zero sugar

protein shakes

• For fat you can use Almonds, avocado, seeds, coconut oil or peanut butter (one small spoon) on

your shakes

• Fresh veggies (especially leafy green veggies)

• Strawberries, berries, cherries, apples and grapefruit

• Low fat milk (6oz tops), plain Greek yogurt

• Use olive oil for salads, vinaigrettes (don’t cook with olive oil)

• Continue to strive for.5 g of protein per 1 pound of ideal body weight, approximately 60-75 g of

protein every day, then up to .8 g per 1 pound of ideal body weight.

• Try to get to 900 calories ASAP and then 1,200. From there you’ll need to increase your caloric

intake and macros based on your physical activity.

• This style of eating is similar to “Paleo,” use that term to search for recipes online

Optimal macro counts for 900 and 1200 calories:

• Protein: 90 g / 120 g • Carbs: 70 g / 90 g • Fat: 30 g / 40 g

Always choose vegetables

NOT sugar or starches (no bread,

potatoes, pasta, rice)



Post-Surgery Nutrition First 3-5 Days Post-Surgery – Clear Liquids Only

The goal is to keep you hydrated and get nutrients into you ASAP. Bring your favorite herbal tea or bouillon

cubes to make broth. Bring a Ziploc bag of protein powder with you. Plan to try a protein shake, even a

small one, the day you leave the hotel. The protein shakes and Multivitamins we recommend can be

purchased here: https://blifestyle.store/

Day 1 - The hospital Day 2 - The hospital/hotel Day 3-5 Leave the hotel & travel

(provided to you) (provided to you) Water & Diluted juice

Water & Ice chips Water & Ice chips Clear broth

Diluted Gatorade / juice Herbal tea

Clear broth Sugar free popsicles or jello

You can attempt a protein shake

Time Meal or

Snack

Day 6-7 Day 8-9 Day 10-11-12

Fluid 8-16 oz. water (or

equivalent)

8-16 oz. water (or

equivalent)

8-16 oz. water (or

equivalent)

Breakfast Protein shake 8-16 oz. skim milk 8-16 oz. sugar-free hot

cocoa made with skim milk

Fluid 8-16 oz. water 8-16 oz. water 8-16 oz. water

Snack 1 8-16 oz. skim milk Protein shake Protein shake


Lunch 8-16 oz. beef broth with

protein powder Liquid iron

supplement

½ cup sugar-free gelatin

Liquid iron supplement

4 ounces fruit juice diluted

with 4 ounces water


Snack 2 1 sugar-free ice pop Protein shake Protein shake


Dinner Protein shake 8-16 oz. chicken broth with

protein powder

8-16 oz. beef broth with

protein powder


Snack 3 ½ cup sugar-free gelatin 1 sugar-free ice pop 8-16 oz. skim milk

https://blifestyle.store/



Time Meal or Snack Day 13 Day 14 Day 15 Day 16


equivalent)

8-16 oz. water (or

equivalent) 8-16 oz. water (or


equivalent)

Breakfast

Chewable multivitamin/mineral Sublingual B12

Scrambled eggs: ¼

cup liquid egg

substitute

scrambled with 1 tsp. margarine; ½ mashed banana

½ cup oatmeal

made with fat-free

milk or soymilk

½ cup fat-free

Greek yogurt (no

sugar added)

¼ cup fat-free

cottage cheese

1 oz. lean ham

Fluid 8-16 oz. water 8-16 oz. water 8-16 oz. water 8-16 oz. water

Protein Supplement 1

Protein shake Protein shake Protein shake Protein shake


Lunch Chewable calcium

¼ cup pureed tuna

½ cup pureed

cooked carrots

2 oz. ground turkey ½ cup

unsweetened

applesauce

1 cup

pureed

vegetable soup with protein

powder

½ cup fat-free

refried beans ¼

cup pureed salsa 2

Tbsp. avocado



Protein shake Protein shake Protein shake Protein shake


Dinner Iron supplement

2 oz. ground

turkey blended

with ¼ cup cooked carrots ¼ cup mashed

potatoes

2 oz. pureed

boneless fish ½

cup mashed

sweet

potatoes ½ cup

pureed canned

green beans

½ cup soft tofu

½ cup pureed

cooked

cauliflower ½

cup

unsweetened

applesauce

½ cup acorn

squash pureed with 1 oz. fat-free

parmesan 1 4-oz. sugar-free

pudding cup




Time Meal or Snack Day 17 Day 18 Day 19




equivalent)

Breakfast

Chewable multivitamin/mineral Sublingual B12

Scrambled egg: 1 egg

with 1 oz. fat-free

cheddar cheese

½ cup unsweetened applesauce ½ cup fat-free Greek

yogurt (no sugar added)

¼ cup fat-free ricotta cheese 1 hard-boiled egg



Protein shake Protein shake Protein shake



¼ cup pureed canned chicken ½ cup mashed sweet potatoes

1 cup pureed cream of

chicken soup made with

fat-free milk

½ cup fat-free cottage cheese ½ mashed banana



Protein shake Protein shake Protein shake



2 oz. pureed chicken

½ cup pureed green

beans

¼ cup canned mackerel

½ cup cooked pureed

beets

2 oz. pureed canned

chicken ¼ cup mashed potatoes

¼ cup pureed cooked

carrots






Breakfast

Chewable multivitamin/mineral

Sublingual B12 B complex

1 scrambled egg

with 1 oz. fat-free cheese.

½ cup cooked

cream of

wheat made

with fat free

milk

2 slices lowfat

turkey bacon

1 hardboiled

egg

¼ cup liquid

egg substitute

scrambled

with 1 oz. diced ham and

½ cup cooked

spinach


Snack 1 ½ banana ¼ cup fat-free

cottage cheese

8-16 oz.

protein shake

1 oz. fat-free

cheese 1 protein shake



2 oz. sliced lean ham ½ cup cooked

carrots ½ cup

applesauce

½ cup fatfree

refried beans

¼ cup cooked

salsa 2 Tbsp.

avocado

½ cup acorn

or butternut

squash 1 oz.

fat-free

parmesan

cheese

¼ cup canned

chicken breast

½ cup canned

green beans


Snack 2 1 low-fat cheese

stick (string cheese) 2 oz. lean ham ½ cup cut ripe

honeydew

melon

¼ cup fat-free

cottage cheese 1 hard-boiled

egg



½ cup cooked

zucchini ½

cup tomato sauce 2 oz. extra lean

ground beef 1 oz. fat-free

mozzarella

3 oz. broiled

boneless fish ½ cup cooked

peas ½ cup canned

pears in 100% juice

2 oz. chicken

breast stewed

with ½ cup

bell pepper

slices 1 small

apple, peeled

and stewed

with

cinnamon

½ cup low-fat

turkey chili ½

cup cooked

frozen

broccoli (if

tolerated)




Time Meal or Snack Day 24 Day 25 Day 26


Breakfast Chewable

multivitamin/mineral Sublingual B12 B complex

½ cup cooked oatmeal with skim milk ½ cup ripe cantaloupe

½ cup Greek yogurt

½ cup fat-free cottage cheese 2 slices low-fat turkey

bacon


Snack 1 ½ cup canned peaches ¼ cup low-fat ricotta

½ cup cut seedless

watermelon ¼ cup fat-free cottage

cheese

½ cup applesauce



½ cup cooked, peeled eggplant pureed with 1 tsp. olive oil and 1 oz. low-fat parmesan 1 ounce whole grain crackers

¼ cup canned tuna ½

whole wheat pita,

toasted

2 oz. sliced turkey

1 oz. slice low-fat

cheese


Snack 2 1 protein shake ½ cup fat-free refried

beans ¼ cup canned tuna



2 oz. extra lean ground

beef patty ½ cup cooked carrots

½ cup cooked frozen

cauliflower

2 oz. skinless chicken

breast ½ cup mashed potato

with 1 tsp. low-fat

margarine

1 veggie burger patty ½ cup cooked spinach ½ cup canned pears






Breakfast

Chewable multivitamin/mineral

Sublingual B12 B complex

Scrambled eggs: ½

cup liquid egg

substitute scrambled

with 1 tsp. margarine; ½ banana

Breakfast sandwich: ½

whole grain English

muffin; 1 oz. fat-free

cheese; 1 oz. (2 slices)

lean ham

½ cup fat-free

cottage cheese 1

tbsp. sunflower

seeds 1 cup

blueberries

½ cup oatmeal made with

fat-free milk or soymilk 1 tablespoon peanut butter


Snack 1 2 slices turkey breast;

1 Tbsp. light mayo; ½

whole grain English

muffin

1 rice cake 1

tablespoon peanut

butter

1 cup celery

sticks 2 tablespoons

fat-free cream

cheese

1 low-fat cheese stick



Spinach salad with

tomatoes, onions, and

mushrooms 2 ounces grilled

chicken breast 1 cup

fresh berries

Greek salad with

romaine lettuce,

pepper, tomato,

cucumber. 1 oz. fat-free feta 6

olive halves 2 Tbsp.

light dressing

½ cup cooked

spaghetti squash 2 oz. turkey

meatballs ½ lowfat

tomato sauce

Turkey roll-ups: 2 oz. turkey

slices spread with 2 Tbsp.

fat-free cream cheese rolled

up with lettuce or fresh

greens and diced tomatoes


Snack 2 1 low-fat cheese stick

(string cheese)

3 cups air popped popcorn

1 cup fresh fruit

salad 1 hard-boiled egg



3 ounces grilled

salmon 1 cup broccoli 1

small baked sweet

potato

Stir fry: 2 ounces chicken with

1 cup vegetables of

your choice: broccoli,

bell peppers, onions,

choy, mushrooms,

etc. Use 2 tsp.

sesame oil

3 oz. broiled

tilapia crusted

with 1 oz. low-fat

parmesan and ½

oz. ground

almonds ½ cup

spinach

3 oz. grilled or roasted

chicken breast (optional: pre-marinated in

fat-free Italian dressing or teriyaki

sauce) Small side salad with

lettuce, tomatoes, and

cucumber 1 Tbsp. dressing




Suggested Recipes

How to Make Bone Broth: Bone broth is very healing for your digestive tract and full of nutrients

and vitamins. The natural collagen in it can also help improve skin elasticity. If you use whole or rotisserie

chickens during the pre-op diet, save the bones (freeze them until you’re ready, you’ll need 3 per batch).

You can also use a few lbs. of beef soup bones (oven roast @ 450° for 30 minutes first for more flavor).

Add all bones to a large slow cooker. Add 1 Tbsp. of apple cider vinegar (to pull minerals from the bones),

some garlic cloves, and enough water to fill the crock. Turn onto high for 24 hours. Check after 12 hours

and add more water to refill. When finished, strain out all solids and add salt and pepper to taste and

more water if too strong. Store in the refrigerator for up to 5 days or freeze in smaller portions. When

refrigerated, it will ideally have a jelly-like consistency (beef more than chicken) but it will turn liquid when

heated. You can easily remove the fat from the top after it cools. Always use a stove to reheat, not

microwave, to preserve the minerals. Drink the broth alone or use in soups/stews.

Smooth Soup Examples (find recipes online):

Tomato Cream of Chicken or Mushroom (avoid the

chunks) Try searching for “Low Carb”

or “Paleo” soups. You can

always blend a soup to make

it smooth.

Pureed Broccoli Pureed Cauliflower & Cheese

Cucumber & Dill Blended Gazpacho

Easy Smooth Vegetable Soup 2 cups chicken broth + 2 cups water. Put the broth, water and bouillon in a pot; bring to a boil. Add 1

teaspoon chicken bouillon granules the onion, tomatoes, cauliflower and green beans to the pot. 1 small

onion, diced. Bring to a boil; cover and simmer until the vegetables are very 1 can diced tomatoes tender,

about 30-40 minutes. Puree the soup with an 8 ounces frozen cauliflower immersion or regular blender

until smooth. Adjust the 8 ounces frozen green beans seasoning with salt and pepper to taste. When you

have Salt and pepper, to taste passed the pureed stage, also try adding finely chopped ham or chicken to

the soup after blending the vegetables.



Shredded Chicken & Avocado

Salad 1 cup cooked chicken breast, finely shredded ½ avocado, mashed

2 scallions (green onions), finely chopped

¼ sweet onion, finely chopped

¼ lime, juiced

1 tablespoon chopped fresh cilantro 1 pinch

cayenne pepper (optional) salt and ground black

pepper to taste Combine all ingredients in a

bowl and stir well.

Easy Low Carb Zuppa

Toscana Soup 6 slices bacon, diced

1 ½ cups chopped onions

1 lb. crumbled

Italian sausage

3 minced garlic cloves

4 cups chicken broth

3 cups chopped cauliflower 3 cups chopped kale (no stems) 1 cup heavy cream

Cook bacon, drain & set aside. Cook sausage & onions, add garlic for 1 minute, then remove from heat and drain excess fat. Combine bacon, sausage, onions, garlic, broth, & cauliflower in large pot. Bring to a boil then simmer 20 minutes to soften cauliflower.

Add kale, simmer 5 minutes.

Remove from heat, stir in cream &

serve.

Chicken & Cauliflower Soup 2 cups chopped cauliflower

1 cup of diced white onion

3 cups of chicken broth

3 cups of shredded cooked chicken shredded

cheese to top

Combine cauliflower, broth, and diced onion in large pot. Bring to boil, then simmer 20 - 25 minutes until cauliflower is soft. Puree or blend the soup until smooth. Return to heat and add chicken. Add salt & pepper to taste. Serve with cheese on top.

Season with garlic powder, Italian seasoning, Buffalo sauce,

salsa, or your favorite seasoning blend.

To add plain protein powder into soups or beverages without clumps, mix the powder with a little water

until smooth, then pour into your cup.



Medical Follow Up with Your Primary Care Physician

Information about the follow up that you and your PCP should know: I recommend monitoring: calcium,

vitamin B12, ferritin, thyroid panel, folate and iron indices with blood tests at 3, 6, 12, 24 months

postoperatively and yearly thereafter. These are due to the vitamin deficiencies that may be related to

the nature of the surgery.

A complete screening it would be good to include:

CBC (Complete Blood Count)

Chemistry panel:

o Creatinine

o BUN

o Glucose o Lipid panel

• Total Cholesterol

• Low density lipoproteins (LDL) High density lipoproteins (HDL)

o Protein:

• Albumin • Total Protein

o Electrolytes:

• Sodium

• Potassium

• Calcium

• Chloride

• Carbon dioxide (CO2)

o Liver Tests:

• Alkaline phosphatase (ALP)

• Alanine amino transferase (ALT)

• Aspartate amino transferase (AST) • Bilirubin

o Vitamin D o Vitamin B12 o Ferritin, Transferrin and Iron o Folate o Thyroid

hormones (T3, T4 and TSH)



Epilogue

So, this is the end of this book, but it is also the beginning of your journey.

This book has compiled a set of diverse knowledge and experiences I’ve learn after 5000+ weight loss

surgeries but most importantly, AFTER TALKING TO HUNDREDS AND HUNDREDS OF MY PATIENTS before

and after surgery.

The take home message is that Life is giving you a second chance to regain control of your life. Obesity is

a disease but it’s also a symptom. A symptom telling you something is wrong or out of balance in your life,

telling you that for whatever reason (anxiety, stress, depression) you can’t have self-control or discipline

and that you’re not giving you the time to take care of yourself.

I decided to dedicate my life to fight one of the biggest health problems in the world one Sleeve at the

time, because I’ve seen the potential inside of every one of you, the potential to be happy, full of energy,

to do things you believe were impossible for you. This is a surgery that save lives in the way that some

people were really death before finding this new self that allows them to be free, to forgive themselves

and make their whole world better.

¡THANK YOU VERY MUCH FOR CONTACTING ME AND HOPE TO

SEE YOU SOON TO START YOUR TRANSFORMATION!

dr. carlos altamirano [email protected] bariatric

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