NUTRITION GUIDELINES FOR LAP-BAND PATIENTS

Lap-band surgery was developed to induce weight loss. However, some behavior pattern must be modified simultaneously in order to achieve and maintain the desired weight loss.
After surgery, you will need to make changes in your eating habits, not only to prevent complications, but also to produce the desired weight loss. It is very important to follow the eating and drinking instructions right from the start after the operation. This will prevent band slippage and obstruction of the stoma (the opening for foods leaving the upper stomach). It is important, especially in the early weeks, not to stretch the small stomach pouch above the band.

EATING METHODS Eat slowly and chew foods until they reach a mushy consistency. Swallowing food in chunks may block the opening and prevent the passage of food. The following are hints to help you eat more slowly:

• Set aside 30 to 45 minutes to eat each meal,
• Actually count the number of times you chew each bite. Aim for 30.
• Make an EAT SLOWLY sign and place it on the table in front of you.
• Explain to family members why you must eat slowly so they will not urge you to eat faster.
• Take small bites of food. You may want to try eating with a baby spoon.
• Pay attention to taste. Learn to savor each bite, noticing its flavor, texture, and consistency.
• Chew well. Ground or very soft foods may be necessary if you have dentures.

 Stop eating as soon as you are "satisfied". Once your stomach is full, your body receives a signal that you have eaten enough. It takes time, though for you to become aware of this signal. If you hurry your meal, you may eat more than you need. Besides causing you to vomit, extra food over a period of time may stretch your stomach. Try to recognize the feeling of fullness. Then stop eating at once. Indications of fullness may be:

• A feeling of pressure or fullness in the center of your abdomen just below the rib cage.
• Feelings of nausea.
• Pain in your shoulder area or upper chest.

If you start vomiting, and it continues throughout the day, stop eating solid foods and just sip clear liquids (gelatin, clear juice, broth, and tea). The vomiting may indicate that your outlet is blocked. If intermittent vomiting continues for more than 24 hours, contact your doctor. Most vomiting episodes can be prevented. The causes of vomiting are:

• Eating too fast and not chewing food properly.
• Eating too much at a meal.
• Drinking liquids right after eating.
• Lying down after a meal.
• Eating foods that don't agree with you.

Set aside three mealtimes per day and eat solid foods only at these times. The LAP-BAND system creates a small stomach pouch that can hold only about half a cup (3 to 4 oz.) of food. If you try to eat more than this at one time you may become nauseous. You may also vomit. If you routinely eat too much, the small stomach pouch may stretch. Frequent vomiting can also cause certain complications, such as stomach slippage. You need to learn how much your stomach pouch can hold comfortably and then not exceed this amount. It is important to eat nourishing foods and to avoid the habit of snacking. Eating often throughout the day may keep you from losing weight because you will be able to eat enough calories to maintain that weight. Individuals who continuously munch on crackers, potato chips or other foods have not only failed to lose but have even gained weight.

Drink four to six cups of liquids per clay between meals. Liquids are needed to replace normal body water losses and thus prevent dehydration. Recommended beverages are skim milk, water, tea, coffee, and low-calorie drinks. Individual need will vary, but you should drink at least 6-8 glasses of water a day.

Do not drink while you are eating. If you drink at mealtimes, the food you have eaten becomes liquid. Then the effectiveness of the LAP-BAND system is greatly reduced. You should not drink anything for at least one hour after a meal. That way you can keep the feeling of fullness as long as possible.

Sip beverages slowly. One way to begin is by taking sips of beverages from a medicine cup or shot glass instead of drinking from a regular glass.

Eliminate high-calorie drinks. Milkshakes, soda pop, beer, and other alcoholic beverages are very high in calories. By sipping on high-calorie liquids throughout the day, many calories are absorbed without creating the effect of fullness. This will result in a poor weight loss record. Avoid carbonated liquids because they could increase the size of the pouch creating discomfort.

Do not eat between meals. Eating snacks between meals is one of the major reasons for weight-loss failure. It is very important to break this habit.
Eat a balanced diet. Because the quantity of food you can consume at a meal is reduced, it is important that what you do eat be of good nutritional value. Do not fill your small stomach pouch with "junk" food that lacks vitamins and other important nutrients. Eating foods from each of the four food groups will provide adequate amounts of protein, vitamins, and minerals for your needs.

Exercise at least 30 minutes a day. Since physical activity consumes energy and burns calories, it is very important to successful weight loss. Exercise can help improve your general health. Start with simple activities such as walking and swimming. Gradually expand your program to include more vigorous forms of exercise such as cycling. Jogging and aerobics. Increase your activity level in the course of daily living. For example — stand rather than sit, walk rather than stand, be outside rather than inside, walk rather than drive, climb the stairs rather than use the elevator, etc.

PROGRESSION OF THE DIET DURING HOSPITALIZATION

After surgery, in addition to water you will first be offered clear liquids. Clear liquids include gelatin, clear juice, and broth.

In time, your diet will include blended and pureed foods. Blended foods, because chunks of food can obstruct the opening for foods leaving the stomach, causing you to vomit and experience pain. You may be tempted to restrict your diet to liquids, but this will prevent you from developing the habit of chewing your food properly.

Many things can cause discomfort and vomiting. Sometimes it may be a specific food. However, you should be careful not to avoid a food just because you vomited once after eating it. You may wish to wait a day or two, but then you should try the specific food
again.

PROGRESSING THE DIET AT HOME

 First week after surgery. You will be on a clear liquid diet. Clear liquids include clear broth or soup (with no vegetables or meat and not creamy, jello, fruit juice (no nectars). water, tea, coffee.

Second week after surgery. You will continue on liquids but adding liquids that have a thicker consistency such as: milk (preferably skim), low-fat yogurt, cream of wheat, oatmeal, creamy soups, and fruit smoothies. (Nothing that you will have to chew).

Third week after surgery. In addition to the pureed foods such as blended meat, meat paste, liverwurst, yogurt (not raspberry or other types containing seeds), you may begin to add cottage cheese, sliced cheese, cheese dishes, scrambled and hard boiled eggs, and fish. You may also slowly add soft canned fruits and vegetables. Baked potatoes (without the skin), rice, macaroni, noodles, ready-to-eat corn or rice cereals.

Fourth to sixth week after surgery. You may begin to add meats that are ground after cooking, such as pork, veal, chicken, turkey, and beef. After your checkup you can begin to experiment more with food. Sliced meats as well as raw fruits and vegetables may be tried. Remember to chew them very well. If you feel hungry between meals you may sip on low-calorie drinks

It is very important that you eat food high in protein at each of your three meals and drink 1-2 cups of milk between meals. Protein is needed for wound healing and to renew body cells.          

The recommended daily dietary allowance (RDA) for protein is:

 56 Gms/day for men
46 Gms/day for women

You wont be able to eat the amount listed above, but you should try to eat 25-30 Gms of protein each day.

Certain foods may be difficult to tolerate. Since toleration for these foods varies from individual to individual, use your own discretion as to whether to include them in your diet. Through trial and error you may find that you are able to tolerate some of these food items, but there may be others which your digestive system cannot handle as well.

• Tough meats, especially hamburger (Even after grinding, the gristle in hamburger is difficult to digest)
• Membranes of oranges or grapefruit
• Cores. seeds, or skins of fruits or vegetables
• Fibrous vegetables such as corn, celery, or sweet potatoes
• Bread
• Chili or other highly spiced foods
• Fried foods
• Milk (Milk is an important part of your diet that supplies much needed protein and calcium. If you are unable to tolerate it as a beverage, it should be incorporated into the diet through foods such as soup, pudding, or cheese.)

Certain foods MUST be avoided. These foods have a concentrated supply of calories with little nutritional value. These empty-calorie foods should be left out of your healthy diet. Sugar and foodstuffs containing large quantities of sugar such as high calorie soft drinks, syrups, cakes, biscuits, sweets, jam, marmalade, honey. High fat foods including chocolate, chips, pies, pastries. Alcoholic drinks should also be avoided as much as possible. These are drinks such as beer, wine, liquors, port, sherry, cocktails, champagne.

REMEMBER!

It is important to:

• Eat slowly
• Chew food well
• Don't drink during meals
• Drink liquids 30 minutes before or at least 60 minutes after meals
• Stop eating when you are full
• Eat three meals; avoid snacking
• Sip low-calorie beverages between meals
• Select a balanced diet
• Exercise regularly

For successful weight loss after Adjustable Gastric Banding surgery. a change in your eating habits is necessary. The operation alone is not a cure--it is not magical. You will not be able to lose as much weight as you like if you eat continuously, or if you stretch your stomach by eating large amounts of food at one time. You will achieve your desired weight loss only if you are willing to control what you eat, and the way in which you eat it.