Basic Eating Guidelines after Laparoscopic Adjustable Gastric Band Surgery

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1 University of Minnesota Medical Center, Fairview Basic Eating Guidelines after Laparoscopic Adjustable Gastric Band Surgery Dr. Ikramuddin, Dr. Kellogg and Dr. Leslie If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.

2 2 Basic Eating Guidelines Your gastric band allows you to feel full with only a small amount of food. We will adjust your gastric band as needed to help you lose weight. We will check your band often in the first year or two after surgery. Our goal is to control your hunger as much as possible during this time. You will have about 10 short clinic visits in the first year. After that, you will return every 6 months for the rest of life. At each clinic visit, we will decide together if your band has too little, too much or the right amount of fluid. If we decide to adjust your band, we will add or remove fluid. The exact amount of fluid is different for each person. The band should be tight enough to control your hunger and help you lose weight. It should still allow you to get the nutrition you need. Your band is empty right after surgery. This allows your body time to heal and gives you time to get used to the band. Your first adjustment will be eight weeks after surgery. To get the best results, you must be very careful in the first few weeks after surgery. You will need to: Avoid vomiting (throwing up). Avoid putting pressure on your new stomach pouch above the band. Please follow the guidelines in this booklet. These will protect your gastric band and help you lose weight.

3 Basic Eating Guidelines 3 Guidelines for eating Eat three small meals per day. No snacking. Snacking or eating throughout the day will keep you from losing weight. It may even cause weight gain because you are eating too many calories. If you feel like snacking, it may mean that your band is not adjusted well. In this case, you should come back to the clinic. Eat small amounts no more than 1/2 cup of food per meal. Your stomach pouch can only hold this much. If you try to eat more than this, you may get sick and your pouch will slowly stretch over time. To keep the weight off, you will need to eat small amounts of food for the rest of your life. Stop eating as soon as you feel full. Always throw away some food at the end of each meal. Eat slowly. Each meal should last 20 to 30 minutes. Eating too fast can cause you to eat too much before you feel full. It can also cause nausea, vomiting (throwing up) and pain or pressure in the shoulder or upper chest. Chew all foods into a paste. If you swallow larger pieces of food, it may block the outlet of the pouch. Use a small fork or spoon to control your bite size. Eat at least 50 to 60 grams of protein per day. Try to include a good source of protein with each meal (such as eggs, lean meats, and low-fat or fat-free milk products). Avoid sugar and fat. Eat a well balanced diet. Do not fill your small stomach pouch with junk foods that lack vitamins and other important nutrients.

4 4 Basic Eating Guidelines Guidelines for liquids Do not drink liquids with meals. Stop drinking 30 minutes before your meals. Then wait 30 minutes after eating to drink liquids again. This will: Prevent the pouch from overfilling Keep food from flushing out of the pouch too quickly Keep you feeling full longer Sip all liquids slowly. Drinking too quickly may cause nausea or vomiting. Drink plenty of calorie-free liquids between meals. Plain water is best. Drink at least 6 to 8 cups per day. Avoid high-calorie liquids. These add extra calories without making you feel full. For example, do not drink: Regular soda pop Coffee drinks (mocha, latte, cappuccino or other specialty drinks) Kool-Aid Smoothies Alcohol Anything with sugar Fruit juice Avoid carbonated (fizzy) liquids. These can cause gas and bloating. Limit caffeine. Caffeine may make you hungry and may irritate your stomach pouch.

5 Basic Eating Guidelines 5 Other important guidelines Take a multi-vitamin with minerals daily. A chewable form works well. (If you are taking a children s form, take the adult dose listed on the label. If you are taking an adult form, take one per day.) After one month, you may switch to a non-chewable form and cut large pills into 2 or 3 small pieces. You should also take 1200 mg calcium with vitamin D per day. Get regular exercise. Since exercise uses energy and burns calories, it is very important for weight loss. Your size may make it hard for you to exercise as much as you should at first. But get started, even if it is just a little. The more weight you lose, the easier it should get. In the first months after surgery, you will move from clear liquids to regular foods. Week 1 clear liquids Week 2 full liquids Weeks 3 and 4 pureed foods Weeks 5 through 8 soft foods Week 9 regular foods Please read the guidelines for each stage of your diet. Please keep in mind that everyone progresses at a different rate. If you have problems like throwing up or feeling sick to your stomach you may need to go back to an earlier stage. For example, if you are on soft foods, step back to a pureed diet. Then, slowly move to the next stage in your diet. (If you have started a regular diet, please see note on page 18.)

6 6 Basic Eating Guidelines Clear liquid diet (week 1) Goal Slowly sip 6 to 8 cups of liquid throughout day. (Drinking too quickly can cause nausea, vomiting and pain or pressure.) Tips Freeze liquids in plastic bottles to carry with you. Do not use a straw. Straws bring air into the stomach pouch, causing gas, bloating and pain or pressure in the shoulder or upper chest. Suggested liquids Water Iced tea Sugar-free Popsicles Frozen fruit pops Clear broth Sport drinks such as Gatorade (add water to dilute) or Propel Crystal Light Cranberry juice or 100% apple or grape juice (add extra water to dilute; limit to ½ cup per day) Decaf coffee or tea with no sugar or honey (artificial sweeteners are okay) Sugar-free Jell-O

7 Basic Eating Guidelines 7 Full liquid diet (week 2) Goals Add foods that are slightly thicker than clear liquids. Bring more protein into your diet. Keep sipping liquids throughout the day. Start taking your multi-vitamin with minerals. Tips Between meals, sip on skim milk, 1% milk or sugar-free Carnation Instant Breakfast. This will increase your protein. Limit your total to 1 to 2 cups per day. Ask your dietitian if you should add dry skim milk or protein powder to liquids. Suggested liquids and foods Clear liquids (see week 1) Skim or 1% milk Carnation Instant Breakfast (no sugar added or low-carb) Low-calorie yogurt (no chunks of fruit) Hot cereals (Cream of Wheat, Cream of Rice, Malt-O-Meal, plain instant or quick-cooking oatmeal) made with low-fat milk instead of water Strained cream soups made with low-fat milk Sugar-free pudding

8 8 Basic Eating Guidelines Sample Menu for Full Liquid Diet Breakfast ¼ cup Cream of Wheat ¼ cup low-calorie yogurt (no chunks of fruit) 30 minutes after breakfast: ½ cup Carnation Instant Breakfast Lunch ¼ cup strained cream soup ¼ cup sugar-free pudding 30 minutes after lunch: ½ cup Carnation Instant Breakfast

9 Basic Eating Guidelines 9 Sample Menu for Full Liquid Diet Dinner ½ cup low-calorie yogurt (no chunks of fruit) 30 minutes after dinner: ½ cup skim or 1% milk 30 minutes later: ½ cup fruit juice

10 10 Basic Eating Guidelines Pureed diet (weeks 3 and 4) Goals Add more food choices. Foods are blended (pureed) to reduce the risk of nausea, vomiting and band slippage. Keep drinking enough liquids. Remember to stop liquids 30 minutes before your meals. Wait 30 minutes after eating to start liquids again. Tips Add new foods slowly. Try one new food at a time. Eat the protein part of your meal first. Suggested foods Proteins: Skim or 1% milk Carnation Instant Breakfast (no sugar added or low-carb) Low-calorie yogurt (no chunks of fruit) Strained cream soups Low-fat cottage cheese or ricotta cheese Scrambled egg or Egg Beaters Mashed tofu

11 Basic Eating Guidelines 11 Pureed lean beef, lean pork, chicken, turkey or fish (or use baby food meats) Mashed beans (such as black beans, pinto beans or fat-free refried beans) Grains and starches: Hot cereals (Cream of Wheat, Cream of Rice, Malt-O-Meal, oatmeal, grits) Mashed potatoes Mashed sweet potatoes Mashed winter squash Fruits and vegetables: 100% fruit juice (add water to dilute). Limit yourself to ½ cup per day. Plain applesauce (no added sugar) Mashed bananas Pureed peaches, pears, apricots or other fruit Tomato juice V8 juice Pureed carrots, green beans, beets or other vegetables

12 12 Basic Eating Guidelines Breakfast ¼ cup scrambled eggs ¼ cup oatmeal Sample Menu for Pureed Diet 30 minutes after breakfast: ½ cup Carnation Instant Breakfast Lunch ¼ cup mashed low-fat cottage cheese ¼ cup pureed peaches 30 minutes after lunch: ½ cup Carnation Instant Breakfast

13 Basic Eating Guidelines 13 Sample Menu for Pureed Diet Dinner ¼ cup pureed chicken or baby food meat ¹ 8 cup pureed green beans ¹ 8 cup applesauce 30 minutes after dinner: ½ cup skim or 1% milk 30 minutes later: ½ cup fruit juice

14 14 Basic Eating Guidelines Soft diet (weeks 5 through 8) Goals Add slightly thicker foods to your diet, including soft (or ground) protein foods. Eat a wide range of low-fat, low-calorie starches, fruits and vegetables. Keep drinking at least 6 to 8 cups of liquid per day. Stop eating as soon as you feel full. Tips Add new foods slowly. You may have problems with some foods more than others. Take small bites and chew all food well. Always eat the protein part of your meal first. Suggested foods Proteins: Tuna fish or salmon White fish Shrimp, lobster or crab Chopped lean meats Lean ground beef or turkey Deli-sliced turkey breast, chicken, ham, roast beef Low-fat cheese (such as part-skim mozzarella)

15 Basic Eating Guidelines 15 Egg, chicken or tuna salad (use low-fat or fat-free mayo or salad dressing) Hard-boiled or poached eggs Tofu Mashed or well-cooked beans (such as black or pinto) Grains and starches: Mashed or baked potatoes Cereals soaked in milk (like Cornflakes) or hot cereals Well-cooked pasta Low-fat crackers Toast (if your body can handle crackers) Fruits and vegetables: Canned peaches or pears (packed in juice, not syrup) Thawed frozen berries (plain, no syrup) Bananas Plain applesauce (no added sugar) Mandarin oranges Soft melon Soft, well-cooked vegetables (carrots, green beans, squash, beets, broccoli)

16 16 Basic Eating Guidelines Breakfast Poached egg ¼ piece toast Sample Menu for Soft Diet 30 minutes after breakfast: ½ cup Carnation Instant Breakfast Lunch ¼ cup chopped chicken ¼ cup cooked carrots 30 minutes after lunch: ½ cup Carnation Instant Breakfast

17 Basic Eating Guidelines 17 Dinner ¼ cup tuna salad 3 to 4 low-fat crackers 2 fresh strawberries Sample Menu for Soft Diet 30 minutes after dinner: ½ cup skim or 1% milk 30 minutes later: ½ cup fruit juice

18 18 Basic Eating Guidelines Regular diet (week 9) During this phase, you should be eating a regular diet. This will include foods with more texture and crunch, such as raw fruits and vegetables. This new diet is a complete change from the liquid diet you had right after surgery. For example: You may not have any liquid calories. If it has calories and can easily spill from a spoon, avoid it. If you can only eat food in a liquid form, it may mean that your band is too tight. In this case, you will need to come back to the clinic. You may only eat foods that contain nutrients. No junk foods. If you get sick: Once you start a regular diet, do not go back to an earlier stage without telling us. If you throw up or feel sick to your stomach, call the clinic. We may need to adjust your band. Goals Eat three small, well-balanced, nutrient-dense meals each day. Each full meal should be about ½ a cup. Be sure to get enough protein. Keep drinking at least 6 to 8 cups liquid per day. Almost all of your liquid should be water or calorie-free drinks. Avoid foods that are high in sugar and fat. Stop eating as soon as you feel full. Keep taking your multi-vitamin with minerals and calcium with vitamin D. You will do this for the rest of your life.

19 Basic Eating Guidelines 19 Breakfast ¼ cup yogurt or egg ¼ cup fruit, no sugar Sample Menu for Regular Diet 1 cup skim or 1% milk At least 1 cup water or calorie-free drink Lunch 2 ounces meat, fish, chicken, turkey ¼ cup vegetable 1 cup skim or 1% milk At least 1 cup water or calorie-free drink Dinner 2 ounces meat, fish, chicken, turkey ¼ cup fruit, no sugar At least 1 cup water or calorie-free drink

20 Phone numbers If you have any questions or concerns, please call one of these numbers. Surgery clinic To make or cancel appointments Triage nurse For non-emergency questions Dietitians For nutrition questions Emergency room TTY for hearing impaired Dr. Ikramuddin, Dr. Kellogg or Dr. Leslie The surgeons are usually in the operating room during the day Hospital operator or a.m. to 4:30 p.m., Monday through Friday On evenings, weekends and holidays, call the hospital operator and ask for the resident who is on call for Dr. Ikramuddin, Dr. Kellogg or Dr. Leslie. You can also call Unit 7B at For information only. Not to replace the advice of your health care provider. Copyright 2005 Fairview Health Services. All rights reserved. SMARTworks REV 05/08.

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