Adjustable gastric band surgery is designed to limit the amount of food you are able to eat. Your stomach pouch will be the size of a large walnut. It is very important to follow the nutrition guidelines the day after your operation to allow the new stomach to completely heal and the band to stay in the right position. It usually takes about a month or more for this to happen.
It is important, especially in the early weeks, not to stretch the small pouch above the band. Vomiting can do this, so it is very important not to vomit. Vomiting can increase the chance of stomach tissue slipping up through the band.
The rate of weight loss is slower with the adjustable gastric band because there is no malabsorption component like there is with gastric bypass surgery.
It is vital that you make healthy food choices and lifestyle choices, and that you exercise after surgery. This will help you:
. achieve maximum weight loss
. avoid gastric discomfort
. prevent nutritional deficiencies
. Stage 1: Clear liquids — Day of surgery.
. Stage 2: Puréed food — One to two days after surgery. Start high-protein foods with full liquids for three weeks.
. Stage 3: Semi-solid food — Four weeks after surgery.
. Stage 4: Low-fat solid food — Eight to 10 weeks after surgery
After surgery, you will begin sipping clear liquids during your hospital stay (apple juice, orange juice, water, sugar-free Jell-O, broth, etc.). Take small sips, and be aware of feelings of fullness. You will be allowed to advance to full liquids in the evening if you are tolerating clear liquids without difficulty.
Advance to puréed foods the morning after surgery. All foods must be puréed in a blender and thinned to a texture that will fit through a straw. However, do not use straws as it may increase gas.
All foods must be the consistency of applesauce for four weeks. You should consume 60 to 72 grams of protein per day.
. Skim or 1 percent milk
. No sugar added Carnation Breakfast Essentials Light Start® made with skim milk
. Pureed soups (made with skim milk instead of water)
. Pureed fruit added to shakes (made with skim milk and light/nonfat yogurt)
. Pureed meat added to pureed low-fat cream soups or mashed potatoes
. Cooked cereal thinned with skim milk (oatmeal, grits, Cream of Wheat)
. Thinned, blended casseroles
. Pureed beans (black, pintos, lima, kidney, northern, butter, lentils)
. Unsweetened applesauce with non-fat dry milk powder
. Fat-free refried beans with melted fat-free/reduced-fat cheese
. Mashed potatoes made with skim milk
. Pureed sugar-free yogurt
. Cottage cheese (fat free/low fat)
. Add nonfat dry milk powder to all foods
Start with small amounts (1/2 to 3/4 cup) of liquids and puréed foods because you will feel full quickly. At first, you will aim for six small meals per day. Eating frequently, you will have 4 to 6 ounces of puréed foods per meal. Eventually, you will be able to eat three meals of 4 to 6 ounces each.
Eat slowly. It should take 30 minutes to eat 4 to 6 ounces (1/2 to 3/4 cup).
Drink at least 8 cups of low-calorie liquids. Liquids should be consumed gradually throughout the day to prevent dehydration. These liquids should be sipped in between meals. Do not drink with meals, and wait 30 to 45 minutes after a meal to begin drinking fluids again.
. Water or sugar-free or zero-calorie flavored water
. Decaffeinated tea (unsweetened or with Splenda)
. Decaffeinated coffee
. Skim milk
. Sugar-free orange or fruit punch
A multivitamin with minerals, which includes iron and zinc, should be taken daily for the rest of your life to prevent hair loss, improve overall nutrition and prevent any nutritional deficiencies. During the first six weeks after surgery, we recommend a chewable vitamin and mineral supplement (example: Flintstone's chewable, twice a day), and then you may advance to a pill form of a multivitamin with minerals if you desire.
You will also be required to take a calcium supplement (example: Calcium Citrate, 600 milligrams, three times per day) starting during the first month after surgery and a vitamin B12 supplement (example: sublingual B12, 1,000 micrograms, three times per week) starting immediately after surgery. Additional vitamin and mineral supplements will be recommended based on lab results and food intake/tolerance to prevent any nutritional deficiencies.
Medications may be taken in chewable or pill form four weeks after surgery.
Concentrated sugars, high fat foods, fried foods and alcohol can cause vomiting and/or diarrhea (dumping syndrome) so avoid:
. Candy, including chocolate
. Regular soft drinks
. Flavored drink mixes
. Ice cream
. Alcohol (including beer)
. Fried foods
Different people have different foods they can and cannot tolerate. Do not be disturbed if you find some foods do not agree with you at first. You may be able to tolerate those foods later.
This will help you monitor your intake and tolerance to foods. Look for patterns of foods tolerated well and foods that are not tolerated well. Food records will also help your dietitian provide suggestions for better tolerance or nutrient balance. Track the following:
. Time you ate
. Type of food (e.g., baked chicken without skin)
. Amount eaten (e.g., 1/2 chicken breast or 1/2 sugar-free yogurt)
. How your food was prepared (e.g., baked with broth). Be sure to include any butter, oil, grease or margarine that was added to the food.
. Grams of protein. Look on food labels, handouts in your patient notebook, the internet or books to determine your total protein intake.
Each cube holds about 2 ounces. This will help you control portion sizes. Try preparing reduced-fat cream soups or puréed meats and vegetables, and store item in the trays.
Protein comes first
Puréed baby food can be used instead of pureed foods. Only meat (puréed beef, pork, chicken) baby foods contain protein.
This stage begins at the end of three weeks after surgery (the beginning of week four). Your dietitian will review how to successfully introduce semisolid consistency foods without nausea and vomiting. At this point, you will advance to soft and easily tolerated foods.
Focus on protein first at meals, and avoid foods that are high in fat and sugar and difficult to digest. You may still need to consume protein from skim milk or supplements as between meal snacks until you are able to tolerate enough semisolid foods to meet your protein needs. Remember, add only one new food at a time, and observe your reaction to test your tolerance.
You should consume three to four small meals per day.
. Cooked eggs, any type except fried
. Casseroles, such as macaroni and cheese, or tuna with light mayo (limited)
. Chopped lean meat (except red meat)
. Low-fat cottage cheese
. Cooked vegetables (peeled)
. Beans and legumes
. Softened cold cereal (non-sugar coated)
. Canned fruits (in their own juices or water)
. Skim milk, unsweetened instant breakfast drinks, sugar-free low-fat yogurt
. Canned chicken
. Soft fish
. Shredded or soft, low-fat cheese
. Light yogurt
Keep in mind that you are "re-educating" your stomach. When you eat too fast or too much, or don't chew enough, you will feel discomfort and vomit. Use the following tips during Stage 3.
. Eat three small meals and two snacks per day.
. Each meal should not exceed 6 ounces total.
. Eat and drink slowly. Take at least 1/2 hour to eat a meal.
. Take small bites, and chew very well. Sip on liquids during meals only if needed, but don't drink large amounts during meals (limit to 1 ounce of fluid per meal).
. Continue to drink low-calorie liquids between meals — at least 6 to 8 cups per day.
. Continue to take a vitamin and mineral supplement every day.
. Avoid red meats.
. Avoid raw vegetables and raw fruits with skins.
. Avoid nuts and popcorn.
. Avoid all fibrous foods (may cause blockage).
. Avoid high-calorie beverages such as soft drinks, juices, milkshakes and protein drinks. You will feel discomfort and vomit.
. Breakfast: 1/2 cup oatmeal made with skim milk and 2 tablespoons dry milk powder
. Lunch: 2 ounces of lean meat (such as turkey, low-fat ham), 1 slice of reduced-fat/fat-free cheese, 1/2 whole wheat tortilla
. Snack: 1 cup skim milk with 2 tablespoons nonfat dry milk powder (if needed)
. Supper: 1/3 cup tuna and 1/4 cup cooked vegetables
Begin this stage when directed by your physician and dietitian. This will generally be about eight to 10 weeks after surgery. Slowly introduce solid foods by adding one new food at a time, and observe your reaction to it.
Add breads last because they tend to form a ball, which will not go through the pouch easily. You can experiment with red meat, raw vegetables and raw fruits with skins.
Remember to chew all food very well, and sip limited amounts of liquids with meals, if necessary.
At this stage, eat only three very small meals per day. No snacking unless you are waiting longer than six hours between meals; then you can add one snack (less than 100 calories). Stop eating at the first sensation of abdominal pressure or fullness.
Select a balanced meal plan, choosing foods from all groups in MyPlate. This is the time to develop your lifelong meal plan and exercise routine. Avoid sugar, sweets and desserts. Also avoid high-fat foods such as cream soups, gravy and butter.
A well-balanced meal plan is very important. Eat foods from all food groups:
. Dairy products
. Beans and legumes
. Fruits and vegetables
. Lean meat and eggs
. Whole wheat bread and whole grain products, such as cereals, brown rice and oatmeal
Protein is important, especially to help with healing after surgery and to help prevent hair loss and the loss of lean muscle mass. As your body adjusts to the change made during surgery and to rapid weight loss, you may experience some hair loss three to six months after surgery. Hair loss may also be related to poor protein, iron and zinc intake, and certain medications. To improve nutrition and help avoid hair loss, focus on eating protein first at meals including:
. Skim or 1 percent milk
. Low-fat cottage cheese
. Low-fat or nonfat yogurt with artificial sweeteners
. Egg whites
. Low-fat cheese
. Oatmeal and Cream of Wheat made with skim milk
. Chicken and turkey
. Other lean meats (pork tenderloin, extra lean ground beef)
. Legumes (dried beans)
. Nonfat dry milk powder (added to casseroles, soups, hot cereals, etc.)
You may not be able to tolerate meat or poultry after your surgery. Until you are able to eat meat and poultry, you must get protein from other protein sources.
It is recommended that you take a vitamin and mineral supplement with iron and zinc daily -- Calcium Citrate 600 milligrams twice a day and a vitamin B-complex or B12 supplement. Any additional vitamin and mineral supplements will be recommended by your surgeon and dietitian based on your food intake and lab values.
To help with weight loss and lifelong weight maintenance, remember to limit your fat and calorie intake. Limit/avoid these high-fat foods and beverages, except in small amounts:
. Olives (healthy fat)
. Nuts (healthy fat)
. Avocados (healthy fat)
. Regular mayonnaise
. Sour cream
. Cream cheese
. Pie crust
. Whole milk
. Butter, margarine
. Hot dogs
. Peanut butter (healthy fat)
. Granola (some are high fat)
. Whole milk cheese
. Potato salad, pasta salads
. Snack crackers
. Ice cream
. Shortening, lard
. Regular salad dressings
. Fried foods
. Bacon, sausage, bologna
. Potato chips
. All oils (use olive or canola oil in moderation)
. Regular soft drinks, high-sugar drinks
Learn to read food labels for fat content. Aim for no more than 35 grams of fat per day. If you do not understand food labels, our dietitian will teach you.