Dietary Guidelines After Bariatric Surgery

Dietary Guidelines After Bariatric Surgery Information for Patients After Gastric Banding 1

Contents Introduction Page 3 Rules for eating after gastric band Page 5 Stage 1 Liquid only Page 6 Stage 2 Puree texture Page 7 Sample Stage 2 Meal Plan Page 8 Stage 3 Soft texture Page 9 Stage 4 Normal texture Page 10 Sample Stage 4 Meal Plan Page 11 Healthy Eating Page 12 FAQ Page 13 General Points and Contact Info Page 14 2

Introduction The placement of a gastric band has been shown to help people lose weight by making them feel full with smaller quantities of food. To achieve and maintain a successful weight loss you also need to change your diet. This diet sheet explains how you can work with the gastric band to get the best results possible for you. What Does Gastric Banding Involve? The gastric band is placed around the upper part of the stomach to create a small upper pouch (15-30mls). There are different types of bands. Some are placed in deflated and others require a small amount of fluid to be added to fix the band in place. After the band is placed the upper pouch only holds a small amount of food. Food passes slowly from the upper pouch to the lower part of the stomach (the diagram below shows the flow of food through the stomach). Attached to the gastric band is tubing that connects it to a port-site. The port-site is placed under the skin and is placed on the breastbone or under the ribcage. (Positioning of the port site can vary depending on the surgeon s or individual s preference). The purpose of the port-site is so that the band can be inflated or deflated. Inflating the band makes food sit for longer in the upper pouch. You will feel full quicker and it will reduce the amount you eat. Gastric Banding 3

How is the band inflated? The band can be adjusted by putting a fine needle through the skin into the port-site and adding or removing fluid. The amount of fluid required to inflate or deflate the band varies from person to person. The initial band inflation usually takes place 6-8 weeks after the operation and you will be required to return regularly for band inflations. Your surgeon / specialist nurse will inflate the band. Band inflation is generally performed in general outpatients. Don t try to inflate the band yourself. How will the gastric band help me lose weight? As mentioned earlier the band when inserted is not inflated or may only contain a small amount of fluid. Until the band is inflated 6-8 weeks after the operation you may not lose much weight. It may take several inflations for you to start achieving a steady weight loss. The gastric band restricts the amount of food you can eat, but to maximise weight loss it is important that you make diet and lifestyle changes. It is very important to choose food of a high nutritional quality to ensure you stay healthy and well nourished. Try to see the time after the gastric band as a fresh new start. Try to choose a diet low in fat and sugar and ensure if possible that high sugar / high calorie drinks are kept to a minimum. Your dietitian will provide you with dietary advice and ongoing support and advice. 4

General Rules for Eating After a Gastric Band It is important that you: Eat slowly, stop immediately when you feel full Chew your food well Choose foods of a high nutritional quality Eat small portions Do not eat and drink at the same time. Allow 10 minutes before and 30 minutes after It is important that you take a multivitamin and mineral supplement. Your dietitian will advice you on a suitable brand. You should take this tablet for at least 6 months, unless advised otherwise. Usually within 24 hours of the operation you will be started on sips of water and then progress to sipping any fluids (except fizzy drinks). There are various stages when you start eating to progress through, these are: - Stage 1 liquid only diet for approximately the first 2 weeks after surgery Stage 2 blended / puree texture from approximately week 2 to week 4 Stage 3 soft texture from approximately week 4 after surgery Stage 4 normal texture when ready Why am I advised to follow a liquid diet and / or blended / puree textured foods? (Stage 1 and 2) Fluids and blended / puree textured foods pass easily through the band. This allows time for the band to settle and fully attach to the wall of the stomach. It is very important that in the early stages you try not to overfill the band as this may lead to pain and discomfort and distension and can cause vomiting. This can lead to band movement. Before leaving hospital all of your medication may be changed to a chewable / dissolved form to help you manage your medication. 5

Liquid only diet (Stage 1) It is more difficult to meet your nutritional requirement on a fluid diet therefore you need to choose nutritious liquids. The following liquids are suitable: Milk Soup with no lumps (make condensed soups up with milk) Build Up soups and drink Complan Slimfast Ovaltine / Horlicks Yoghurt (no fruit lumps), low fat custard, fromage frais Fruit juice, tomato juice Low sugar fruit squash, flavoured water Fruit smoothie (blended fruit and semi/skimmed milk or low fat / diet / light yoghurt). You may need to dilute with water and sieve any bits out Liquids to avoid: Fizzy, sparkling drinks Alcohol Any liquid with bits or lumps Aim for 6-8 cups (2-2.5litres / 3.5-4 pints) of drinks a day to prevent dehydration and constipation. Sip at drinks. Some people find it useful to carry a bottle of fluid with them. Fizzy drinks may cause discomfort, therefore they are best avoided in the early stages. 6

Blended / Puree Textured Diet (Stage 2) Follow this stage from approximately 2 weeks after surgery until approximately 4 weeks after surgery. Below are the general principles to consider during this stage:- 3 small meals with snacks in between. Keep to the recommended portion sizes to prevent the band dislodging. Chew food well and stop as soon as you feel full. Sip at drinks between meals and aim for 6-8 cups (2-2.5 litres / 3.5-4 pints) / day. Fizzy drinks may cause discomfort, therefore they are best avoided in the early stages. Do not eat and drink at the same time allow 10 minutes before and 30 minutes after eating before drinking. Serve all food on a side plate or ramekin dish. Aim initially for just 2-3 tbsp at each meal or snack. Blended / Puree Textured Diet All food should be a smooth texture i.e. yoghurt. You may need to use a food processor, liquidiser, blender or mash well to achieve the texture. Tips for preparing blended dishes Use minced meat or chicken or casserole slowly. Blend with sauce or gravy. Mash potatoes with semi/skimmed milk and liquidise. Instant mash can be a useful alternative. Soft pasta blends well if extra sauce is added. Try to choose a tomato-based sauce or small pasta shapes in a sauce and mash with a fork. Boil vegetables in a small amount of water till tender, drain and mash / blend. Mash / blend tinned, fresh or stewed fruit and add extra fruit juice for the desired consistency. Add artificial sweetener as required. Use herbs to flavour dishes as a blended diet can be bland. Try to blend dishes separately i.e. separate blended potatoes from blended meats, appearance and taste are important at this stage. Cook meat dishes in bulk and blend and freeze in individual portions. Homemade soups or healthy eating main course can be blended before eating. 7

Sample Meal Ideas for Stage 2 Breakfast 1/2 weetabix with plenty of semi-skimmed milk 1 sachet of instant oats / Ready Brek with semi-skimmed milk 1 small pot of smooth low fat / diet / light yoghurt Banana blended with 1 small pot of low fat / diet / light yoghurt 150-200mls (approx 1/3 pint) fruit smoothie (blended fruit and semi/skimmed milk or low fat / diet / light yoghurt) Lunch / Evening Meal 1 tbsp. Blended white fish in a parsley / white sauce with 1 tbsp. Mashed potato and 1tbsp. Mashed / blended vegetables 1 tbsp. Turkey or beef blended with gravy granules or stock cube with 1 tbsp. Mashed potato / instant mash / pasta and 1 tbsp. Mashed / blended vegetables 1 tbsp. Blended bolognaise sauce (mince and tomato sauce) with 1 tbsp. Mashed potato / instant mash / pasta and 1 tbsp. Mashed / blended vegetables. 150-200mls (approx 1/3 pint) small bowl blended homemade soup or main course soup containing meat, chicken or lentils and vegetables. 2-3 tbsp. Blended cauliflower cheese / macaroni cheese and mashed / blended vegetables. 2 tbsp. Blended casserole meats with mashed potato / instant mash 2 tbsp. Mashed potato with 1/2oz (15g) grated cheese. Suitable in between meal snacks 2-3 tbsp. Low fat custard (1/2 pot) 1 small low fat / diet / light yoghurt / mousse 2-3 tbsp. Blended peeled fresh fruit / tinned fruit in natural juice 150-200mls (approx 1/3 pint) fruit smoothie Glass of semi/skimmed milk Small bowl of sugar free jelly Egg custard, crème caramel (1/2 pot) 8

Soft Texture (Stage 3) After approximately 4 weeks following surgery gradually start to introduce foods with a soft texture (soft foods should mash easily with a fork). Continue to follow the blended texture but gradually start to experiment with some of the foods listed below. Remember to chew food well and stop as soon as you feel full. Try to introduce a variety of food from this stage before progressing to the next stage. Fish in parsley or white sauce with mashed potato and soft vegetables Minced meat in a tomato based sauce with pasta Soft omelette / scrambled egg Tinned meats in sauce / vegetables and tinned fruit (tinned varieties may be more convenient and are more likely to be the required texture) Macaroni cheese / cauliflower cheese Healthy eating ready meals such as fish pie, cottage pie, lasagne and cannelloni may be useful When you are tolerating a variety of food from Stage 3 move on to Stage 4. 9

Normal texture (Stage 4) Continue to include foods from Stage 3 but gradually introduce foods with a normal texture. It is advisable to initially try adding in foods with a crispy texture as these are usually easily tolerated. These are foods that melt easily on the tongue (i.e. breadsticks / melba toast / crackers / crispbread with a thin scarping of spread). Points to consider during Stage 4 Remember to chew food well and stop as soon as you feel full Allow time to sit down for meals Continue to separate drinks from meals. Allow 10 minutes before and 30 minutes after a meal Continue to sip at fluids throughout the day Choose a healthy balanced diet (for further information see later sections in this booklet) If you are at the stage where you are eating a tea-plate portion size, try to aim for 3 regular meals with healthy snacks in between if necessary. Do not eat whilst driving. As the weeks pass by you will find that you may begin to feel hungry and you are able to eat more at mealtimes. Below are some general ideas on how portion sizes will alter and what portions work up to:- 1 small bowl of cereal (approx. 6tbsp) 1-2 slices of toast (if tolerated) 3-4 tbsp boiled rice 4-6 tbsp boiled pasta 3 slices of a lean meat / small chicken breast Small tin of baked beans 2-4 egg sized boiled potatoes / small baked potato 10

Sample Menu Plan for Stage 4 Breakfast 1 small bowl of branflakes (with semi/skimmed milk) Lunch Jacket potato with cheese or beans or Crackers (crispbread) with low fat cheese or toast if tolerated Evening Meal Small potatoes, slices of chicken breast in a mushroom sauce and vegetables Drinks Reduced sugar / no added sugar squash Tea / coffee with semi/skimmed milk (no sugar / sweetener if required) Water Fruit juice (1-2 small glasses daily) Snacks If you are feeling hungry between meals, try to choose a healthy snack i.e. fresh fruit (take care with the skin), tinned fruit in natural juice, 1-2 crispbreads / breadsticks / melba toast / toast / cracker / rice cakes, low fat / diet / light yoghurt / fromage frais. You may find that as your band is inflated portion sizes reduce further than those stated above Caution Foods Some foods are not well tolerated. This will vary from person to person and with type of band inserted. Caution foods include:- Bread (especially soft white, non-toasted) Roasted or barbecued meat Fibrous vegetables e.g. green beans, celery, cabbage Skins on fruit e.g. apples Overcooked rice and pasta Nuts and dried fruit Foods which are not restricted by the band Some foods are not affected by the band such as crisps, chocolate, sweets and mints, alcohol, ice cream and high calorie drinks such as milk shakes. Eating these foods regularly will stop you losing weight. Try not to stack on these foods in between meals. 11

Healthy Eating with a Gastric Band To lose weight and stay healthy you need to follow a balanced diet. Protein foods Consume 2-3 portions per day e.g. casserole or minced meat, chicken, fish (fresh, frozen or tinned), eggs, pulses (for example baked beans, kidney beans, lentils and dahl), milk, cheese, yoghurt, nuts, hummous, Quorn, soya mince, tofu. Starchy foods Try to have a portion at each meal. Suitable foods include breakfast cereals, bread, potato, rice, pasta, couscous, crackers, crispbreads, crumpets, naan bread, chapatti, pitta bread, break sticks, sweet potato, yam. Fruit and vegetables The recommendations for health is 5 portions a day. Try to work towards this, initially have 2-3 portions per day and increase as tolerated. Dairy foods These are an important source of calcium in the diet. Have 2-3 portions a day. Milk (try skimmed or semi-skimmed), hard cheese, soft cheese (e.g. cheese spread, low fat cream cheese, cottage cheese and fromage frais in diet / low fat varieties). Fatty and sugary foods These provide little or no nutrition and so should be used in moderation or best avoided. Do not add sugar to drinks Choose lower sugar / sugar free / diet drinks Avoid cakes, biscuits, sweets and chocolate Avoid fried food and pastry Cook meat with no added fat e.g. grill, bake, steam or microwave Choose low fat sauces, salad dressing choose varieties that are less than 5% fat (5g per 100g) Alcohol Contains no nutrition and is high in calories. Excess alcohol consumption will stop you losing weight. Limit your consumption. 12

Frequently Asked Questions Should I expect to be sick or vomit? You should not expect to be sick or to vomit regularly. It has a potential effect of dislodging the band and in the long-term limiting weight loss if the sickness is caused by overeating. If you suffer from sickness or vomiting ask yourself the following questions:- Did I eat too quickly? Did I chew the food well? Was the food of the correct consistency? Did I allow enough time between my drink and my meal? Did I overeat? Remember that it is important that you try and allow time for regular meals. Try to sit down for meals and chew food well. Try serving your meals on a tea-plate What can I do if I get constipation? If you get constipated you can take a non-bulking agent such as Benefiber, Lactulose or Senna. To prevent constipation ensure you are drinking sufficient fluids and choose foods higher in fibre such as wholegrain cereals, bread, fruit and vegetables. Seek medical help if it becomes a problem. Can I continue to eat a normal textured diet after the band is inflated? After each band inflation you may need to go back to a blended / puree textured diet (Stage 2) again and work your way back through the stages over the space of a few days. 13

General Points to Consider When Returning to a Normal Textured Diet Eat slowly, chew your food well Aim for 3 regular meals, try not to replace meals with easily tolerated high calorie snacks such as crisps or chocolate Choose a diet low in fat and low in sugar Do not eat and drink at the same time Aim for 6-8 cups (2-2.5 litres / 3.5-4 pints) of fluid each day to prevent dehydration and constipation. You may find it useful to carry a water bottle to ensure you are drinking enough Allow a maximum of 30 minutes for meals Try to choose solids at meals rather than liquids. This is because fluids pass easily through the band. Solids should sit above the band and as they are slowly digested the food passes through the band Choose tender meats i.e. stew, casserole, hot pot or add a low fat sauce or gravy as this may be better tolerated Serve food on a small plate or side plate 14