Dietary advice following intragastric balloon insertion. Information for patients Sheffield Dietetics

Transcription

1 Dietary advice following intragastric balloon insertion Information for patients Sheffield Dietetics

2 Intragastric balloon information A fluid-filled silicone balloon has been placed into your stomach. The balloon partially fills the stomach and will create a feeling of fullness. This will help reduce the amount of food eaten and reduce your appetite. This should help you lose weight. The balloon is designed to stay in place for 6 months, after which it must be removed in a very similar way to how it was inserted. After the balloon has been inserted, it may take a few days for your body to adjust and get used to the balloon. You may experience short term nausea (feeling sick), vomiting (being sick), heartburn, bloating and cramping. You will initially begin to take small sips of fluid only. Over the next few weeks, you will gradually build up the texture of food from a pureed diet to a solid textured diet. Your portion size should be no more than a tea plate size. Over time, the balloon will reduce your feelings of hunger. However, how successful you are at achieving weight loss will still be determined by your food choices and exercise. page 2 of 16

3 General dietary advice Initially a meal will consist of 2-3 tablespoons of pureed foods (see menu plan, stage 2). If you get acid reflux or bloating, stop eating. Avoid all fizzy drinks as this will increase the acid and make you feel bloated. Eat slowly. It should take you up to 20 minutes to eat a tea plate sized portion. Chew all your foods thoroughly before swallowing. Avoid snacking in between meals, this will slow your weight loss and possibly increase your appetite. Avoid going back to meals once you feel full, this will slow your weight loss. Stop eating as soon as you feel full, otherwise you may get pain and be sick. Avoid taking food and fluid together, as this is likely to make you sick. Wait half an hour before and after meals to have a drink. Aim for at least 2 litres of low calorie fluids per day. Take regular slow, small drinks of fluids throughout the day. Choose low sugar/reduced sugar or diet, non fizzy drinks. Use artificial sweeteners instead of sugar. You may find it more convenient to freeze meals in ice cube containers, so that meals can be prepared quickly and food is not wasted. Cooking methods It is important to consider the cooking methods that you use to reduce your fat and calorie intake. Avoid frying and roasting. Grill, bake, microwave, stew, poach, boil and steam instead. page 3 of 16

4 Fat Fat is a very concentrated source of calories and can be difficult to digest after the gastric balloon. Fat can delay stomach emptying and lead to heartburn. Eating these high fat foods will slow your weight loss. High fat foods to avoid are: Fatty meats and products, such as sausages, paté, corned beef, bacon, scotch eggs, sausage rolls, pasties, kebabs, pork pie, quiche and burgers. All fried foods Mayonnaise Salad dressings Whole milk Condensed milk Evaporated milk Cream, cream cakes Butter / margarine / lard / dripping / oil / ghee Full fat cheese Full fat yoghurts Biscuits Cake Crisps Chips Nuts Pastries Samosas Foods covered in batter Fatty sauces, such as creamy sauces and curry from a jar or ready meal page 4 of 16

5 Protein It is important to get adequate protein in your diet. Protein will help preserve your muscle and encourage your fat stores to be used as energy. Foods high in protein and low fat foods include: Fish and shellfish Semi-skimmed or skimmed milk Lean meat, such as chicken, turkey, low fat mince Peas, beans and lentils Eggs Soya, tofu and Quorn Light cream / reduced fat soft cheese Cottage cheese Diet / light yoghurts Fromage frais Sugary / sweet foods and fluids to avoid These foods are likely to slow your weight loss. Foods that contain sugar tend to be high in calories and fat and provide few, if any, vitamins and minerals. Sugar-free and artificial sweeteners such as Canderel, Splenda and Sweetex are advised as alternatives. Full sugar fizzy drinks, such as cola, lemonade, ginger beer Full sugar cordials and squashes Mints, toffees, boiled sweets (unless sugar-free) Energy drinks, such as Lucozade, Powerade, Red Bull Sugar added to tea and coffee Full sugar jelly Jam, marmalade, lemon curd Honey page 5 of 16

6 Icing Syrup, treacle, glucose syrup Chocolate biscuits Cake Puddings Ice cream and sorbet The intragastric balloon diet There are four stages to the intragastric balloon diet - 1. Fluids only 2. Smooth, pureed diet 3. Soft, mushy, crispy diet 4. Solid textured diet The exact time of progressing to the next stage varies between individuals. It is important to ensure that you do not rush each stage and move on before you are ready. You are less likely to have problems if you begin carefully. If you are sick and/or have pain after eating, one or more of the following may have occurred: You ate too much The texture of the food was unsuitable You ate too quickly You had fluid and food too close together Stage 1 - Fluids only You will be able to begin taking fluids soon after the balloon has been placed into your stomach. Start with sips of water and then gradually build up to small (25-30mls), slow, drinks. page 6 of 16

7 It is important that you drink at least two litres of fluid (approximately 8 cups) per day to ensure that you do not become dehydrated and to help prevent constipation. Fluids to choose are: Water Low calorie, reduced sugar and no-added sugar squash Non-fizzy diet drinks Tea Herbal tea Coffee Semi-skimmed or skimmed milk Diluted fruit juice (half water and half fruit juice) Smooth thin, strained soup Thin liquid fruit smoothies Meal replacements, such as Slim Fast, Meritene (Build Up) or Complan Diet or light malted / chocolate drinks, such as Highlights, Options and Horlicks light You should avoid high calorie / sugary drinks, such as full sugar fizzy drinks, squashes, cordials, whole milk, full sugar drinking chocolate / malted drinks and alcohol. Fizzy drinks should be avoided in the long-term as they may make you feel bloated and can cause heartburn and bloatedness. You will need to take small, slow, frequent sips of fluid throughout the day. Once you can tolerate small sips of fluids you will move onto stage two, which is usually after 3-7 days. page 7 of 16

8 Stage 2 - Low calorie liquids / smooth pureed diet From day 3 to day 7 onwards you should begin to be able to move onto this stage of the diet. This stage should be followed for approximately two weeks. The pureed diet should be a smooth, custard consistency. There should not be any lumps in the pureed food. The pureed stage should always have a sauce or gravy to ensure that the pureed food is a smooth custard consistency. To begin with you will need to eat small, frequent meals (no more than 2-3 tbsp), 4-6 meals per day. Try to have a source of protein at each of your meals to ensure you have enough protein in your diet. Aim for at least two litres of fluid each day. Wherever you go, take a bottle of water with you. Eat slowly; as soon as you feel full, stop eating, as you may be sick. In time, you will be able to recognise your tolerance level to food and fluid. The stage two meal plan gives you an idea of the types of foods and the portion sizes that you should eat. You are advised to eat the foods that contain protein first. You can use herbs and spices to flavour foods. Meal plan for stage 2 - Liquid / smooth pureed diet Breakfast 2-3 tbsp Weetabix / porridge / Ready Brek with plenty of semi-skimmed or skimmed milk made to a very runny / liquid consistency or 1 very softly cooked, pureed scrambled egg or 50mls diluted fruit juice (half water and half fruit juice) Mid Morning 200mls semi skimmed milk (sipped slowly) page 8 of 16

9 Lunch (1 meal = 2-3 tablespoons) 25g (1oz) blended meat, such as chicken, beef, lamb and turkey or 25g (1oz) blended tender fish, such as haddock, cod or plaice or 25g (1oz) blended tinned fish in water, tomato sauce or brine, such as salmon, tuna, mackerel, pilchards or 50g (2oz) smooth soft meat / fish / vegetable paté / paste or 1 very soft cooked egg (scrambled) or 25g (1oz) light cream cheese or 25g (1oz) grated reduced fat cheese mixed into hot food such as blended potato or 50g (2oz) plain low fat cottage cheese or 1 meal replacement such as Slim Fast, Complan, Meritene (Build Up) With 1 tbsp blended mashed potato and 1 tbsp blended vegetables, such as carrot, cauliflower, swede Mid-afternoon 2-3 tbsp diet / light smooth yoghurt / fromage frais or 2-3 tbsp light mousse made with semi-skimmed / skimmed milk or 2-3 tbsp milky pudding, such as tapioca, sago or rice pudding Evening meal (1 meal = 2-3 tablespoons) 25g (1oz) blended meat, such as chicken, beef, lamb and turkey or 25g (1oz) blended tender fish, such as cod, haddock or plaice or 25g (1oz) blended tinned fish in water, tomato sauce or brine, such as salmon, tuna, mackerel, pilchards or 50g (2oz) blended meat / fish / vegetable paté / paste or 1 very soft cooked egg (scrambled) or 25g (1oz) light cream cheese or 25g (1oz) grated reduced fat cheese mixed into hot food, such as blended potato or 50g (2oz) plain low fat cottage cheese page 9 of 16

10 With 1 tbsp blended mashed potato and 1 tbsp blended vegetables, such as carrot, cauliflower, swede Supper 2-3 tbsp blended banana or blended tinned peaches or blended tinned pears or 200mls semi-skimmed milk (sipped slowly) Only move onto stage three (soft, mushy, crispy), when you feel comfortable with the pureed food and you can manage more than half a tea plate sized portion. This should not be for at least 2 weeks after having your balloon inserted. The pureed foods should not cause any vomiting or acid reflux at this stage. Stage 3 - Soft, mushy, crispy diet You should continue to choose the foods from stage two (pureed), but slowly introduce and replace them with more texture and variety. Begin with 2-3 tablespoons for a meal and gradually increase your portion size to no more than a tea plate. Crispy foods are foods which will fall to bits in water, such as melba toast, crisp breads and bread sticks. They are not the same as crunchy foods such as raw vegetables and salad. Crunchy foods are likely to cause problems if eaten at this stage. page 10 of 16

11 Foods to try and introduce are: Casserole, stew and hot pot Tinned meat, particularly in sauce, such as chicken, ham, stewed steak and pork Wafer thin ham, chicken, turkey or pork Shepherds' pie and fish pie Tinned fish, such as sardines and mackerel in tomato sauce Fish fingers, fish cake, fish pie and fish in sauce Tinned tuna or salmon in reduced fat mayonnaise or salad cream Soft plain omelette 1 soft-boiled egg or poached egg Baked beans, lentils and peas Tinned pasta in sauce, such as ravioli, macaroni cheese, and spaghetti Spaghetti bolognaise, chilli con carne Jacket potato (avoid the skin) Cous cous with tomato based sauce Ratatouille 2 tbsp tinned or softly cooked vegetables, such as carrots, cauliflower, broccoli, tomatoes 1-2 bread sticks, melba toast, cracker, crisp bread or half slice of wholemeal toast (without crust) with low fat spread / light cream cheese / paté / paste Tinned fruit, such as peaches, pears, mandarins Soft fruits, such as raspberries, strawberries, mango, melon, kiwi, banana Only when you are able to tolerate a variety of foods from stage three and you can manage a tea plate sized portion in minutes, should you then move onto stage four (solid textured diet). page 11 of 16

12 Stage 4 - Solid textured diet Once you have moved on to stage 4, you should be able to begin to eat a variety of solid food, up to a tea plate sized portion. These foods will make you feel fuller for longer. It is important to start meals with high protein foods, such as meat, fish, eggs, Quorn, tofu, peas, beans and lentils, to ensure that you have an adequate daily protein intake. Aim to have a good variety of high protein, low fat and low sugar foods in your diet. Fruit and vegetables should be included at each meal as they fill you up and contain vitamins, minerals and fibre. Aim for no more than 3 tea plate size meals per day. Avoid going back to meals once you feel full. Avoid missing meals, as this may also slow your weight loss. Do not snack in between your meals. If you choose to snack on high calorie foods, such as crisps, ice cream, biscuits and chocolate, your weight loss will slow and you may even gain weight. Foods to include are: Softly cooked meat, such as chicken, turkey, pork, and beef, cut up into very small pieces (1cm squares) and chewed thoroughly with gravy / sauce Tender, soft flaky fish, such as salmon, lemon sole and plaice Pasta, rice or noodles in sauce Toasted wholemeal bread, pitta bread, toasted teacake, crumpets Vegetables (less softly cooked than stage 3) Fruit, such as a soft peeled apple, pear or peach Some salad, including tomatoes without skins, cucumber, peppers, beetroot, radishes, onion page 12 of 16

13 Caution foods There are some solid foods, which may not be tolerated in the long term. These foods are more likely to give you pain and make you sick. These foods should only be tried when all other foods are tolerated. The caution foods include: Non-toasted bread, particularly soft and white Pasta and boiled rice Red meat, particularly steak and chops Barbequed meat Stringy vegetables, such as green beans Sweetcorn Mushrooms Lettuce Pineapple Pips, seeds, skins, piths from fruit and vegetables Nuts Dried fruit page 13 of 16

14 Vitamin and mineral supplements To prevent any nutritional deficiencies, it is recommended that you take two complete A-Z multivitamin and mineral tablets per day whilst the gastric balloon is in place. Initially, the supplement should be chewable, until you are on stage 3 (soft, mushy, crispy) stage. This is to make sure it can get past the gastric balloon. These supplements can be bought over the counter at pharmacies, supermarkets or on the internet. Brands include: Boot's Chewable A-Z multivitamins and minerals (two per day) Centrum Chewables (one per day) Nature's Plus Adults Chewable multivitamin and minerals (exotic red fruit flavoured, suitable for vegetarians) (one per day) Once you are able to manage stage 3 foods (soft, mushy, crispy), you should be able to manage vitamin and mineral tablets. Choose a 'complete' A-Z vitamin and mineral supplement. These tablets contain more vitamins and minerals than some of the chewable supplements and you should be taking two per day whilst you have the intragastric balloon in place. Complete vitamin and mineral brands include: Sanatogen A-Z Complete Supermarket own brand A-Z Multivitamins and Minerals Centrum Advance from A to Zinc Boot's Complete A-Z Multivitamin and Mineral Forceval (prescribable) page 14 of 16

15 Useful intragastric balloon dietary tips Take regular, slow, small drinks of fluid throughout the day, aim for at least 2 litres (2000ml or 8 cups) of fluid per day to prevent dehydration and constipation. You may find it useful to take a bottle of water when away from home to ensure that you can take regular drinks and have an adequate daily fluid intake. Have fluids at least 30 minutes before or 30 minutes after meals. Do not take food and fluids together. Chew foods very thoroughly before swallowing. Eat slowly and stop eating as soon as you feel full. If you have problems, such as vomiting, with a particular food, avoid it from your diet for a few days and then retry it. One bad experience doesn't necessarily mean that you are unable to tolerate that food forever. Avoid skins, seeds, pips, piths from fruit and vegetables. Use artificial sweeteners instead of sugar. Eating chocolate, sweets, crisps, cake, ice cream and high calorie liquids will slow your weight loss and you may actually gain weight. On occasions, a food / meal is tolerated one day and then not the next meal or day. This can happen if you have eaten more quickly than the day before or if the food was reheated. page 15 of 16

16 Name:... Specialist Dietitian for Weight Loss Surgery: Clinical Nurse Specialist for Weight Loss Surgery: Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD5235-PIL1711 v5 Issue Date: January Review Date: January 2020