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Nutrition Guidelines After Adjustable Gastric Banding Surgery

The Way to a Healthier Lifestyle

Adjustable gastric banding surgery was developed to induce weight loss and avoid some of the medical complications associated with obesity. This surgery is designed to limit the amount of food you are able to eat. Your 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 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 the gastric bypass. Therefore, it is very vital for you to make healthy food choices and incorporate exercise after your surgery to help you achieve the maximum amount of weight loss and to maintain your nutritional health. A commitment to change eating habits and lifestyles is essential to achieve substantial weight loss, avoid gastric discomfort and to prevent nutritional deficiencies.

Diet Progression

Stage 1 Clear liquids - Start the day of surgery. May advance to full liquids in the evening after surgery.
Stage 2
Puréed consistency - Start high-protein foods with full liquids for three full weeks following surgery.
Stage 3 Semi-solid consistency - Start at the end of your third week after surgery (the beginning of week four). You may advance to this stage before your appointment.
Stage 4 Low-fat solid - Start gradually introducing low-fat solid foods about eight to 10 weeks after surgery.

Stage 1 - LiquidsTop

After your surgery, you will begin sipping liquids during your hospital stay (apple juice, orange juice, water, sugar-free jello, 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.

Stage 2 - Puréed ConsistencyTop

All foods must be puréed in a blender and thinned to a texture that will fit through a straw. However, do not use a straw as it will increase gas.

Advance to puréed foods the morning after surgery. Remember everything must be puréed to an applesauce consistency with no chunks.

Protein Goal = 60 to 72 grams per day

Examples

  • Skim or 1 percent milk
  • No Sugar Added CARNATION® INSTANT BREAKFAST ESSENTIALS™ made with skim milk
  • Blenderized soups (make with skim milk instead of water)
  • Blenderized fruit added to shakes made with skim milk and light/nonfat yogurt
  • Blenderized meat added to blenderized cream soups or mashed potatoes
  • Cooked cereal thinned with skim milk (oatmeal, grits, Cream of Wheat)
  • Blenderized beans (black, pintos, kidney, lima, northern, butter, lentils)
  • Thin blenderized casseroles
  • Unsweetened applesauce with non-fat dry milk powder
  • Fat-free refried beans with melted fat-free/reduced fat cheese
  • Blended light/fat-free yogurt
  • Cottage cheese (fat free/low fat)
  • Add non-fat dry milk powder to all foods and beverages to increase the protein


You will start with small amounts (1/2 to 3/4 cup) of these full 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 two to four ounces of liquid per meal and four to six ounces of puréed foods per meal. Eventually, you will be able to take three meals of four to six ounces each.  

Eat slowly. It should take 30 minutes to eat four to six ounces (1/2 to 3/4 cup).

Drink at least eight 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.

Examples

  • Water or 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 advance to a pill form of a multivitamin with minerals if you desire.

Most pills are easily swallowed, but if you prefer, medications may be taken in liquid or chewable form.

Concentrated sugars; high-fat, fried foods; and alcohol can cause you to consume too many calories and prevent weight loss so avoid:

  • Candy, including chocolate
  • Sweets
  • Regular sodas
  • Honey
  • Flavored drink mix
  • Molasses
  • Restaurant foods
  • Cakes
  • Preserves
  • Sherbet
  • Ice cream
  • Alcohol (including beer)
  • Doughnuts
  • Potato chips
  • 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.

Record your protein intake: read food labels, look on the Internet or at the resources in the patient notebook to help calculate protein intake.

If you are having trouble tolerating puréed food:

  1. Try slowing the speed of your eating.
  2. Decrease your portion size.

How to blenderize food:

  1. Cut food into small pieces about the size of your thumbnail.
  2. Place food in the blender.
  3. Add liquid such as skim milk, broth or fat-free gravy to cover the blades.
  4. Blend until puréed and smooth like applesauce.
  5. Strain out the lumps, seeds or pieces of food.
  6. Use spices and seasonings (avoid spicy ones such as hot sauce and cayenne pepper) to add flavor.
  7. Blend and enjoy!

Tips for the first three weeks:

  1. Keep food records. 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. The records will also be helpful for your dietitian to provide suggestions for better tolerance or nutrient balance.

    Record the:

    1. Time
    2. Type of food (e.g. baked chicken without skin)
    3. Amount eaten (e.g. ½ chicken breast or ½ cup)
    4. How your food was prepared (ex. baked with broth). Be sure to include any butter, oil, grease or margarine that was added to the food.

    Please bring these records with you during all your follow up visits for the dietitian to review.

  2. Use ice cube trays. Each cube holds about two ounces. This will help you control portion sizes. Try preparing reduced-fat cream soups or puréed meats and vegetables and store them in the trays.
  3. Limit food to two to four ounces per meal. Protein comes first.
  4. Aim for four to six small meals per day.
  5. Drink at least six to eight cups (48 to 64 ounces) of fluid per day. Avoid drinking fluids with meals and wait 30 to 45 minutes after a meal to begin your fluid intake throughout the day.

Stage 3 - Semi-solid ConsistencyTop

This stage begins at at the end of three weeks after surgery (the beginning of week four). The dietitian in the hospital will review guidelines on how to successfully introduce semi-solid 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 semi-solid foods to meet your protein needs. Remember, add only one new food at a time and observe your reaction to test your tolerance. 

Cut back on the amount of meals to only three to four small meals per day.

  • Cooked eggs, any type except fried
  • Casseroles, such as macaroni & cheese or tuna with light mayo (limited)
  • Chopped lean meat (except red meat)
  • Low-fat cottage cheese
  • Cooked vegetables (peeled)
  • Beans and legumes
  • Hot cereals made with skim milk
  • Softened cold cereal (non-sugar coated)
  • Canned fruits (in their own juices or water)
  • Crackers, pretzels, hard rolls, bread (toasted)
  • Skim milk, unsweetened instant breakfast, sugar-free low-fat yogurt
  • Canned chicken
  • Soft fish
  • Shredded or soft low-fat cheeses
  • Light yogurts


Specific Information:

  • Eat three to four small meals per day.
  • Each meal should not exceed the volume of six ounces.
  • Eat and drink slowly. Take at least ½ hour to eat a meal.
  • Take small bites and chew very well. Sip on liquids during meals if needed only, but don't drink large amounts during meals. Llimit to one ounce per meal.
  • Continue to drink low-calorie liquids between meals – at least six to eight cups per day.
  • Continue to take the vitamin and mineral supplement everyday.
  • Avoid raw vegetables and raw fruits with skins at this stage in your diet progression.
  • Avoid red meats.
  • Avoid nuts and popcorn.
  • Avoid all fibrous foods (may cause blockage).
  • Avoid high-calorie beverages such as colas, juices, milkshakes and protein drinks.
  • Keep in mind that you are "re-educating" your stomach. When you eat too fast, too much or don't chew enough, you will feel discomfort and might become sick.


Sample Semi-Solid Menu

Breakfast ½ cup oatmeal made with skim milk and 2 tablespoons dry milk powder
Lunch 2 to 3 ounces of lean meat (such as turkey, low-fat ham)
1 slice of reduced-fat or fat-free cheese
½ whole wheat tortilla
Snack 1 cup skim milk
optional: nonfat skim milk powder can be mixed in skim milk to increase protein
Supper ½ cup tuna
¼ cup cooked vegetables

Stage 4 - Low- Fat Solid FoodsTop

Begin this stage when directed by your physician and the dietitian, general 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 (www.choosemyplate.gov), which has replaced the Food Guide Pyramid. 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.

Nutrition Information

A well-balanced meal plan is very important. Eat foods from all food groups:

  • Dairy products
  • Beans and legumes
  • Fruits and vegetables
  • Meat, eggs
  • Whole wheat bread and whole grain products, such as cereals, brown rice, oatmeal

Protein

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 the rapid weight loss, you may experience some hair loss three to six months after surgery. Also, hair loss is 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 from sources 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
  • Fish
  • 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 the other protein sources listed above.

Remember to take a vitamin and mineral supplement with iron and zinc daily; Calcium Citrate 600 mg twice a day; and a B-complex or B12 supplement.

Any additional vitamin/mineral supplements will be recommended by your surgeon and dietitian based on your food intake and lab values.

Fat

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)
  • Muffins
  • Cole slaw
  • Whole milk cheese
  • Potato salad, pasta salads
  • Snack crackers
  • Ice cream
  • Shortening, lard
  • Fat back
  • Regular salad dressings
  • Sauces
  • Fried foods
  • Bacon, sausage, bologna
  • Potato chips
  • Doughnuts
  • All oils (use olive or canola oil, in moderation)
  • Gravy
  • Regular sodas and 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 dietician will teach you.