Nutrition

Dietary Guidelines – Prior To Surgery

We recommend that this diet be started 2 weeks prior to your surgery and you must weigh in with Liz or Carla prior to starting your diet.

The diet consists of:

• 3 cans of Slim Fast Low Carb, Edge, or Advantage a day. 1 can for breakfast, 1 can for lunch and 1 can for dinner or you can have 1 can for breakfast, 1 can for lunch and a small meal for dinner. This meal will consist of a baked piece of chicken breast or fish and a vegetable, or you can have a salad with a chicken breast, 3oz of boiled shrimp or 3oz of crabmeat with a small amount of low-fat dressing.
• All the clear liquids you desire as long as they are sugar free including kool-aid, crystal light, coffee (sweetened with artificial sweetener), tea (sweetened with artificial sweetener)
• Sugar free Jell-O and Popsicles (unlimited).
• Clear beef or chicken broth (unlimited).
• Egg drop soup ( a copy of the recipe is available)
• Please try to drink 64oz of water daily.

 Please try to stay away from bread, rice, potatoes, pasta and desserts.

If at anytime while on this diet you begin to have any ill symptoms, please contact the Bariatric Nurses at 985-850-5282. If after hours, during the weekend or a holiday please call 985-868-2206 to be connected to the Doctor on call.

Diabetics should monitor their blood sugar closely. We recommend that you get in touch with your primary care physician to manage your diabetic needs.

Life after Surgery

One of the benefits of the LAP-BAND® System is that patients return to normal activity relatively quickly after surgery. The length of hospital stay is usually less than 24 hours. It also takes most people about a week to return to work and a month to six weeks to resume strenuous exercising. In the case of open surgery or if there are complications, recovery may take longer.

LAP-BAND® System surgery is the first step on the road to successful and sustained weight loss. However, you must take the next step by adopting a lifelong program that will help you meet your goals. This multifaceted program will include routine check-ups with your surgeon, ongoing band adjustments if necessary, and regular attendance at support group meetings. You will need to work closely with your surgeon and weight-management team, follow their advice, and communicate openly with them. You will also need to learn to use the LAP-BAND® System as a tool to help you lose your excess weight.

Post-Surgery Nutrition

After surgery, you will need a new nutrition plan. Your surgeon, dietitian and/or Bariatric Nurses can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.

In the first 2 weeks after your surgery, you will be on a liquid diet with protein supplements since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to soft foods (three to four weeks post-op) and then you will be able to eat solid foods.

When you can eat solid foods without problems you will need to pay close attention to your diet. The LAP-BAND® System is designed to restrict solids, not liquids, so drinking liquids will not make you feel full. You also should not drink liquids during or immediately after meals as they will flush food through the reduced stomach pouch, which means you will not get the prolonged feeling of satiety needed to help you eat less. However, staying hydrated and drinking lots of water throughout the day is important. You will also need to learn to eat slowly and chew your food very thoroughly.

It is recommended that you eat only when you are hungry and make sure that these meals contain adequate nutrients. You will need to make good food choices and learn to avoid problem foods, such as high-fiber, high-fat, and dry foods, since these are more difficult for the small stomach pouch to digest. Good food choices include fruit and vegetables, lean protein, some bread and cereal, and some dairy products. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible.

Exercise Plan

Incorporating regular physical activity into your daily routine is as important as following your nutrition plan. Often patients have been sedentary due to decreased activity tolerance, psychological constraints, and in some cases, physical disabilities. After LAP-BAND® surgery, aerobic activities—particularly walking and swimming—are generally best tolerated. You will need to consult with your surgeon and weight-management team to find out which activity is right for you.

Adjustments

Being able to adjust the band is a unique feature of the LAP-BAND® System and is a normal part of the post-surgery follow-up. This feature allows your surgeon to the right level of restriction to meet your individual needs.

Adjustments are simple office visits that only take 10 or 15 minutes. They are performed without surgery using a thin needle to inject or withdraw saline from the band via the access port. This widens or narrows the band opening to control the rate of your weight loss. The first adjustment is typically done 4 to 6 weeks after surgery, and the total number of adjustments you may have will depend on your individual weight-loss rate and results.

Your Motivation: Key to Success

To work, the LAP-BAND® System needs your active participation. Your success will depend on you and the partnership between you and your medical team. Your surgeon will not perform the operation unless he or she is sure that you understand the problems your excess weight is causing. Your surgeon will also make sure you understand your responsibilities, including adopting and maintaining new eating patterns and a healthy lifestyle.

Dietary Guidelines – After Surgery

Nutritional guidelines have been established to help promote long-term satisfaction and to achieve and maintain a desired weight.

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Phase I Diet: First 2 weeks after surgery

Restart your daily vitamins.

• Sugar free kool-aid
• Sugar free popcicles
• Sugar free Jello
• Crystal Light
• Coffee (sweetened with artificial sweetener)
• Chicken/Beef broth
• Egg Drop Soup
• Strained Gumbo (juice only)
• Canned soup ( any broth based- juice only)

Liquid Protein Supplements

• Slim Fast (low carb)
• Adkins Advantage
• Edge
• Whey protein bullets
• Profect Protein Bullets
• Slam Protein

Suggestions during this period:
Pre-freeze or refrigerate plastic bottles with the desired liquids (water), and carry bottle with you so that you may sip liquids throughout the day and avoid getting dehydrated.
Increase liquids as tolerated to at least two quarts of liquid a day. Drink enough water or liquid each day so that your urine does not become dark or concentrated.
Do not gulp liquids or drink too quickly.

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Phase 2 Diet: 3 to 4 weeks after surgery
Begin experimenting with your diet by beginning with soft foods. Below is a sample list.

Examples of Phase 2 diet foods:

• Cottage cheese
• Cheese
• Eggs (poached, scrambled, soft-boiled)
• Red Beans , White Beans, Lima Beans and Lentils
• Tuna fish
• Chicken (canned or fresh in food processor)
• Boiled or Baked Seafood
• Tofu

Suggestions during this period:
During this phase, begin the practice of eating only when hungry.
Your meals will consist of 1 to 4 oz. of food per meal. Use small plates and cups, instead of large plates and bowls, for your meals.
You may only be able to tolerate eating 1 or 2 tablespoons of food per meal initially.
Begin the habit of eating slowly and chewing food thoroughly.
Learn to stop eating when you feel full, which may be after only 2 or 3 bites of food. DO NOT EAT UNTIL YOU FEEL STUFFED! Eat only until you feel satisfied. 
Do not drink liquids for 30 minutes prior to mealtime. Do not drink liquids with your meals, and avoid liquids for 30 minutes to 1 hour after meals. This allows your stomach pouch to remain "full" and maximizes your weight loss. Drinking with meals "washes" food out of your stomach and enables you to eat more.
Continue to maintain an intake of at least 2 quarts (or liters) of liquid a day.
 

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Phase 3 Diet: 5 weeks and beyond
Now, it is time to begin experimenting. We recommend that you start with semi-solid food before progressing to solid food (i.e. try cooked carrots before eating raw carrots).

It is important to eat at least 4 oz. of protein (approximately 30-50g) each day. Excellent sources of protein include fish, chicken, beef, pork, turkey, ham, and lentils. PEANUT BUTTER AND CHEESE DO NOT COUNT - although they have some protein, the fat content is extremely high. Use them sparingly. You are trying to lose fat.

Semi-soft Foods to Solids:

• Shrimp or lobster
• Chicken
• Vegetables/salads
• Fresh fruit

Some suggestions for maximum weight loss:
Turn the food pyramid upside-down - eat mostly protein, some fruits and vegetables, and small amounts of breads and pastas. Your body will preferentially metabolize carbohydrates, instead of fat, as the primary fuel.
Splurge a little - since you are only eating a small amount, pay the extra money for the 98% fat free lean beef.
Develop an exercise routine - this builds muscle. The more muscle you have, the more calories you'll burn. You'll lose inches, too!
Don't eat 'til you're stuffed.
Don't eat more than 2-3 meals per day and don't snack!
If you're not hungry, don't eat.
Changing one's eating habits will be important if the operation is to be a success. The smaller upper stomach and smaller new opening that releases the food and liquid into the intestine will help. However, several problems may be encountered once eating is resumed after surgery.

Managing Liquids
Fluids are needed to replace normal water loss and to prevent dehydration. We recommend that you try to drink 2 quarts of liquid (preferably water) every day.
Avoid liquids with meals, saving room for solid foods, and preventing the "washing" of food from the stomach.
Stop drinking fluids 30-40 minutes before a meal, and wait 30-60 minutes after the meal, to allow for digestion of food.
When drinking liquids, slip them slowly. If liquids are gulped too quickly, vomiting may occur.
Avoiding carbonated beverages for approximately 4-6 weeks after surgery can help avoid excess gas and pressure.
Nausea, Vomiting, Bloating, and/or Heartburn
These problems may be caused by the following:
Eating and drinking too quickly
Not chewing food adequately
Drinking cold fluids
Eating too much (quantity)
Eating rich or sweet foods
Eating gas-producing foods or drinking carbonated beverages

Blockage of the Stoma
The new opening created by the surgery is smaller than the original opening that released food from the stomach into the intestine. This new opening may become blocked when food has not been thoroughly chewed; this may result in abdominal pain or vomiting.

Within the first month after surgery, if you become unable to tolerate water, call us immediately. The sooner we catch this problem, the more likely we will be able to treat it without surgery.

To prevent blockage from occurring:
Chew all foods to the consistency of mush before swallowing.
Foods high in fiber, such as raw fruits and vegetables, can cause blockage if they are not chewed thoroughly. Beef may also be a problem food.

Overeating
The purpose of the surgery is to create a smaller stomach; therefore, it cannot hold large volumes of food as it once did. Constant overeating can stretch the pouch. Remember, your pouch is 1 ounce (the size of your thumb). Meals should be between 2 and 4 ounces. The more solid the food, the less you'll be able to eat.  Remember, you need the protein for energy, to heal tissues, to decrease muscle loss and to prevent hair loss.

To prevent stretching the outlet:
Eat only when hungry, measuring the foods before consumption to prevent overfilling the stomach.
Eat slowly so that the nerve receptors in the stomach area can relay the message to the brain that the stomach is full. It takes approximately 15 minutes for the message of fullness to reach the brain. Take time between bites of food. Stop eating as soon as fullness is experienced.
Constant nibbling of foods will reduce the amount of weight lost, especially when consuming foods and beverages that are high in calories and low in nutritive value.
Under-nutrition
Total food consumption is reduced after surgery, and therefore, intake may be nutritionally inadequate.

To compensate for reduced nutrient intake:
Take the recommended vitamins (multi-vitamin, calcium supplement) every day.
Consume foods that are of good nutritional value and not just empty calories.
Consume adequate high biological value protein foods each day.
Food Intolerance
Food intolerance varies widely. For example, one individual may tolerate a food that disagrees with another person. It is important to eat a variety of foods. Each individual must try new foods carefully to test his or her reactions after surgery.

The following foods may be difficult to eat, especially for the first few months:
Tough meats, especially those that are dry with a large amount of gristle; they may be difficult to digest
Bread, especially fresh, doughy bread; it can form a ball and "gum up" the opening from the stomach
Pasta may form a paste and be more difficult to pass
 

It is important to not be discouraged if a certain food does not agree with you once. Wait a few weeks and try it again. Your stomach just might not have been ready for it yet.