NUTRITION GUIDELINES FOR THE GASTRIC BAND
NYU MEDICAL CENTER
NOTE: Liquid diet two weeks prior to surgery.
Pre-Op Liquid Diet Instructions- Start 2 weeks before surgery
You will have 1000 calories per day and at least 50 grams of protein. No more than 35 grams of fat daily.
Most of your calories will come from protein/meal replacement shakes. You are permitted to have low calorie vegetables in small portions at lunch and dinner time.
We suggest the following protein/meal replacement shakes:
Brand Name Calories per serving Protein Drinks per day
Muscle Milk Light (premade or powder available)
(sold at pharmacies or www.gnc.com)
20gms per serving
5 per day provide 800 calories and 100gms protein
(premade or powder available)
(may be purchased in our office)
14gms per serving
6 per day provide 960 calories and 84gms protein
Carnation Instant Breakfast –No Sugar Added
150 calories (premade box or from 1 packet made with skim milk)
12gms per serving
6 per day provide 900 calories and 72gms protein
|Slim Fast: Optima |
, Easy to
Digest, High Protein or Lower Carb
(sold at pharmacies or supermarket)
10-20gms per serving
5 per day provide 900 calories and 50-100gms protein
Ensure High Protein (lactose free)
(sold at pharmacies or supermarkets)
12gms per serving
4 per day provide 920 calories and 48gms protein
Glucerna Shake (lactose free; diabetic formula)
(sold at health food stores)
5 per day provide 1000 calories and 50gms protein
Shaklee Cinch Shake Mix (kosher)
(sold at health food stores) *mix with 8 oz skim milk
5 per day provide 925 calories and 80gms protein
Maxi Health Naturemax Protein Power (kosher)
(sold at health food stores) *mix with 8oz skim milk
5 per day provide 940 calories and 140gms protein
OTHER OPTIONS (to be used for protein supplementation or to help meet protein needs)
Pure Protein by World Wide Challenge (11oz can)
(sold at GNC like stores)
35gms protein per serving
*pre-made and ready to drink
Unjury by Proynthesis Labs
(www.unjury.com or 800-517-5111)
20gms protein per serving
180 calories and 28gms protein if mixed with skim milk
More Pre-op Diet Instructions
(Free foods allowed on pre-op diet)
You may also drink sugar free beverages throughout the day. Water, diet caffeine free soda/diet ice tea, crystal light, diet lemonade, diet Snapple and the like are unlimited. You may chew sugar free gum.
You may have sugar free ices. Limit to 30 calories per day.
Sugar Free Jell-o is OK.
Low salt broth (i.e. Herb Ox) is OK.
Limit caffeinated beverages as they will make it more difficult to stay hydrated. Limit to 2 cups coffee or soda daily. Caffeine free is OK. You may have skim milk and artificial sweetener in coffee.
If hungry, you are permitted to have vegetables (raw or cooked). Steamed, boiled, grilled or in a soup. Limit 2 cups daily.
Permitted vegetables include lettuce, spinach, cucumber, onion, tomato, broccoli, cauliflower, carrots, mushroom, zucchini, string beans, okra, cabbage, asparagus, Brussels sprouts and peppers.
No corn, peas, potatoes, or beans-too many calories.
- Mustard, salsa, vinegar are permitted in small amounts.
- Limit fat free dressing to 2 tablespoons daily.
- NO added fats, oils, butter, margarine, mayonnaise, etc.
NO ALCOHOLIC BEVERAGES ALLOWED during this time as it also impacts your liver adversely.
Compliance to this pre-op diet is mandatory. Remember, this is to help shrink or “de-fat” your liver. Shrinkage of the liver makes the surgery significantly easier.
First 10 days After Surgery – Thin Liquid Diet
© For the first 10 days after the surgery you will be on a thin liquid diet. Anything that is thin enough to be sipped through a straw is fine. For example, choose caffeine-free beverages like Wyler’s Light, diet ice tea, Crystal Light, broth, skim milk, sugar free hot chocolate, tomato juice, tomato soup, water, V8 vegetable juice, Vitamin Water, Decaf coffee/tea, ices, Propel, diluted juice, V8 Splash. Avoid carbonated drinks as they may stretch your new pouch and cause gas. Drinking straws may cause gas too, and should be avoided. After 10 days you will switch to sugar free/no calorie beverages.
© Include AT LEAST, but not limited to, 2 protein shakes per day. You may have a pre-made shake such as Ensure High Protein, Slim Fast Optima, Glucerna Shake, Pure Protein, Naturemax, Shaklee or prepare your own. To prepare your own, blend one scoop of a protein powder such as Designer Protein or GNC Challenge into 4 oz of liquid (preferably milk) with some ice. Carnation Instant Breakfast, ALBA mix, Weight Watcher shake mix can be used as well. Protein drinks may need to be diluted with ice, water or milk.
©Limit fluid intake to sips at a time. Sip your fluid slowly all day long. Do not gulp. HINT: Drink fluid as if you were drinking hot tea. This will prevent your pouch from stretching, and prevent nausea/vomiting. It may take 1 hour to drink 8 ounces of fluid.
©Adequate hydration prevents dehydration and constipation. Have a goal of consuming 6-8, eight oz glasses of fluid per day.
© Medications (if large) will be chewed or crushed for the first 10 days after surgery. You are advised to take a multivitamin supplement after surgery due to your low caloric and nutrient intake. Take 2 chewable children’s multivitamins (i.e. Flintstones) or take an adult liquid or chewable multivitamin each day (i.e. Centrum adult multivitamin chewable or liquid, Maxi Health chewable multivitamin (kosher), or Freeda Monocaps multivitamin (kosher and vegetarian) in chewable or liquid form. It is also recommended that you take a calcium supplement (i.e. Viactiv, Citracal, Caltrate). Continue taking your Juice Plus supplements.
* YOU WILL COME BACK IN 7-10 DAYS AFTER SURGERY FOR A CHECK UP.
Second 10 days After Surgery – Puree Diet
*You can begin eating pureed foods after your two weeks of liquids is completed.
* From this point on you will begin to avoid drinking with meals. Remember to stop drinking 5 minutes before your meal and wait 20 minutes after your meal to drink.
*Focus on a balanced healthy diet with an emphasis on protein and nutrient rich foods. Sample food ideas are below.
*To puree food, cut food into small pieces (size of a pencil eraser) and then cook. Drain the fluid and set it aside. Blend the food and liquid (can be juice or broth, too) in a blender/food processor. Blend until applesauce consistency. Strain any lumps or pieces. Use spices to flavor food. Final consistency should be smooth. Baby food works too.
EASY PUREED IDEAS
HIGH PROTEIN CHOICES®
Meat, Fish, Eggs, Vegetarian Sources
Cooked pureed protein such as: flakey, fork mashed fish (tilapia, flounder). “Wet” Tuna fish or egg salad fork mashed or blended well with low fat mayo (no added vegetables.) Silken tofu, non fat refried beans, hummus, split pea soup. Blended chicken or blended meatballs.
HIGH PROTEIN CHOICES®
Milk, Cheese and Yogurt Protein
Choose 1% or non-fat dairy
Low fat milk, low fat/sugar free yogurt. Ricotta cheese, cottage cheese. Sugar free pudding.
Fruits & Vegetables
Baby food fruits and vegetables, pureed canned fruits and vegetables, low fat creamed spinach, applesauce, pureed squash.
Cream of wheat or farina, mashed potatoes (limit). Runny oatmeal.
Fats and Oils
limit 2-4 tsp.
Use sparingly. Use low fat mayo. Use olive oil and canola oil.
8 (8oz) cups/day
Low or no calories drinks like diet Snapple, crystal lite, water, broth, sugar free ice pops, sugar free Jell-O, tea, sugar free Kool Aid, Fruit 2 0, Propel. Avoid carbonation!
v Shakes (i.e. Slim Fast) may be used as a meal replacement.
v Blended soups can also be a meal. Blend any soup in blender/food processor and serve. May wish to add broth to thin out soup.
These rules begin 10 days after surgery and are to be followed permanently.
© Some lifelong behaviors begin while you start the pureed phase. Remember the pureed phase begins after you have completed the 10 days of liquids.
©A long term goal is to eat only 2-3 meals a day. Start this habit while on the pureed diet. Eat only when you are hungry. Avoid snacking, which will slow down weight loss.
© Note: You can stop taking the protein shakes once you are started on the pureed diet. You may wish to replace a meal (i.e. breakfast) with a shake.
©Remember to take your time at meals (20 minutes per meal). Chew food thoroughly otherwise vomiting will occur. Limit yourself to one teaspoonful of food at a time to allow yourself to chew thoroughly. Chew food until it liquefies before swallowing.
©Stop eating when full. The new small pouch can only hold about half a cup to one cup of food per meal. You may regurgitate your food, become nauseous or experience pain if you overeat. Learn to listen to your body.
© Medications-you may swallow your medications at this time.
©Vitamins – You should continue to take a daily multivitamin with iron at this time. Examples include Centrum Adult Multivitamin, Flintstones Children Multivitamin (take two), Maxi Health chewable multivitamins (kosher) or Freeda Monocaps Multivitamin (kosher and vegetarian) in chewable (take 2 if children’s), tablet or liquid form. It is also recommended that you take a calcium supplement (i.e. Viactiv, Citracal, Caltrate). Continue taking your Juice Plus supplements.
3 Weeks After Surgery
Start Regular Foods
©You will advance to a regular diet in three weeks. There will be certain foods to avoid such as red meat, doughy bread, dry white meat poultry and fibrous foods (such as asparagus and spinach). The white parts of citrus fruits (the membranes) will not be digested and should be removed before eating these fruits.
©Texture is your friend! Soft foods and crunchy foods will go through your stomach smoothly. Foods that tend to “glob up” are more likely to get stuck such as dry white meat chicken, steak and pizza. You can have toasted bread, crackers, dark meat poultry and ground meat.
©Do not drink with your meals. If you drink and eat at the same time you will experience vomiting. Excessive vomiting can lead to band slippage.
©Increase your activity! Exercise can help burn calories, preserve lean muscle mass and will help you lose weight. Check with your Doctor before you begin any exercise program.
©High calorie, high fat and high sugar foods or drinks will sabotage your weight loss efforts and should be avoided.
FOODS TO AVOID
BECAUSE THEY WILL PREVENT WEIGHT LOSS:
These foods are “liquid calorie” food and will slide through the band. You will not be able to feel satisfied/full after consuming these foods. They are very high in calories and will prevent weight loss.
Chocolate Regular soda or ice tea (Diet Is OK)
Hi-C Ice Cream
Kool-Aid Milk Shakes
Fruit Punch Frappuccino
Juices Regular Snapple (Diet Snapple OK)
FOODS TO AVOID
BECAUSE YOU MAY NOT TOLERATE THEM WELL:
These foods may get “stuck” in the band and make you feel sick. No matter how well they are chewed, they may cause problems.
1. Red Meat-steak, pork chops, lamb chops, roast beef, spare ribs, veal. Ground meat is OK.
2. Chicken breast, turkey breast –too dry! Dark meat is OK. Ground turkey or chicken are OK.
3. Doughy bread –rolls, heroes, Italian bread, doughnuts,
croissants. Toasted bread is OK.
4. Miscellaneous: Lettuce should be torn in small pieces or chopped. Spinach should be chopped if you cook it, raw spinach is fine. Bananas and cooked cabbage must be chewed well. Peel off rinds of citrus fruit. Avoid asparagus (tips are OK; avoid the stems-too stringy). Avoid calamari and lobster tail (too tough).
5. Reminder-moist foods work better than dry foods. Marinades, condiments and sauces are great to use to help moisten food.
Texture is your friend: Soft, Crumbly and Crunchy foods work well with the Lap Band!
Fish (the flakier the better-sole, flounder, sea bass, tilapia, cod, haddock, halibut, trout, carp, swordfish, sardines, gefilte fish, etc)
Scallops, crab cakes, lobster claws
Eggs (limit 3 egg yolks per week or choose egg whites or egg beaters)
Cheese (low fat suggested if you eat cheese often)
Processed meats –sliced paper thin and shredded
Dark meat poultry (moist-remove skin)
Ground meat (veal, beef, chicken, turkey) - should be moist
Chili (vegetarian or regular)
Skinless sausage (i.e. turkey sausage, vegetarian sausages)
Fruits & Vegetables (may have to remove skins and cut up into small pieces before eating)
Crispy turkey bacon
Cereal (Fiber one, All bran, Cheerios)
Soy crisps, pretzels, popcorn, wheat thins, Triscuits, dry roasted nuts.
Crackers, breadsticks, Matzo, rice cakes, bagel chips, pita chips, flat breads, Melba toast, water crackers and toasted wheat or rye bread
Well-toasted bagel with cream cheese (scooped out)
French baguette (crust only)
Challah bread (crust only)
Avoid! Canned Pasta (i.e. Chef Boy Ardee)
Sample Liquid Diet –First 10 Days After Surgery
1 cup protein shake
1 cup Propel or tea or coffee
1/2 cup protein shake
1 cup vegetable juice or water
1 cup “Cream” of tomato soup (tomato soup with skim milk-no chunks)
1/2 cup protein shake
1 cup Crystal Light or Wyler’s Light
1 cup broth
1 diet ice pop
§ Try to consume at least 2 protein shakes (Slim Fast Optima, Ensure, Pure Protein, Myoplex Lite, etc.) every day! They will help give you energy and protein. It will help promote wound healing and help preserve muscle.
§ Shake idea: take 4 oz milk, crushed ice, and blend with 1 scoop protein powder (i.e. Designer Whey) to make a protein smoothie.
§ HINT: The first two weeks are the most challenging! It is suggested that you avoid watching TV during this time due to the large number of food commercials. Choose other activities such as reading books, knitting, writing, using the Internet, talking on the telephone, etc., to help keep your mind off of food.
Sample Puree Diet –Second 10 Days After Surgery
(No crunchy raw fruits or vegetables. Food should be fork mashed or blended.) Pick ONE item from each suggested meal.
1. scrambled eggs (1-2 eggs)
2. yogurt (6 ounces)
3. cottage cheese (1/2 cup)
4. farina, cream of wheat (made with milk- ½ cup)
5. applesauce (1/2 cup)
6. protein shake (10 ounces)
Note: All serving sizes are estimated at ½ cup to 1 cup per meal. Stop as soon as you feel full or uncomfortable in any way.
Lunch and Dinner ideas:
1. tuna fish (fork mashed with mayo, no celery)
2. cottage cheese or yogurt and pureed fruit
3. soft white fish with mashed potato
4. eggs with or without cheese
5. egg salad with low fat mayo
6. pureed chicken with mashed potato
7. soup (lentil, pureed vegetable soup, creamed soup)
8. tofu with pureed or soft mashed veggies
9. baby food
Easy Mushy/Pureed High Protein Recipes
The following recipes were created by Judi Lynch, MA.
1. Sweet Ricotta Cheese: Part Skim Ricotta Cheese, Splenda, Cinnamon and Choice of flavored extract like Vanilla or Almond.
2. Noodle-less Lasagna: Part Skim Ricotta Cheese, Ragu, Low fat Mozzarella and Parmesan Cheese. Microwave one minute.
3. Burrito-less Burrito: Refried beans, Taco Sauce or Smooth Salsa, Low Fat Cheddar Cheese. Microwave 1 minute. Top with tablespoon of Low Fat Sour Cream.
4. Deviled Egg Salad: 1-2 Hard Boiled Eggs, Low Fat Mayonnaise, Low Fat Vegetable Cream Cheese. Mush well with Fork. Must be moist!
5. Protein Shake: Scoop of Protein Powder (i.e. Body Fortress Premium Whey Protein Powder, 8 Ounces Skim or 1% Milk. Shake or Blend with ice.
6. Protein Pudding: In a blender put 2 ¼ cups of Skim or 1% milk, 1 package of Sugar Free/Fat Free Instant Pudding and 3 scoops of protein powder. Divide into 3 servings and enjoy as a meal.
Note: All serving sizes are estimated at ½ cup to 1 cup per meal.
For more: Look for it at www.amazon.com or www.half.com or at your local library or bookstore.
Sample Regular Diet – 3 Weeks After Surgery
(Start raw fruits and vegetables)
1. high fiber cereal (i.e Fiber One or oatmeal) and milk
2. wheat toast or crackers with slice of cheese or peanut butter
3. eggs, turkey bacon and wheat toast
4. low fat cottage cheese and melon
5. yogurt and fruit (i.e. 1/2 cup strawberries)
6. oatmeal, farina or grits with milk
7. whole grain waffle with sugar free syrup
NOTE-Breakfast may be too difficult to tolerate. You can replace it with a cup of juice, coffee, tea or a protein shake!
Lunch and dinner ideas:
1. 2 slices low calorie bread toasted with thinly sliced turkey, ham or cheese
2. salad with protein (i.e. cheese or beans) over it and melba toast
3. ¼ cup pasta and chicken, tofu or meat sauce, etc.
4. rice and beans, hard taco shell
5. cooked veggies and baked fish
6. hamburger (no bun) or veggie burger (i.e. Gardenburger)
7. red potatoes (3 ounces) and protein like fish, ground meat or ground veal
8. chili with 1 ounce baked chips and salsa
9. nachos and cheese, ground meat
10. Lean Cuisine type meal
Note: All serving sizes are estimated at ½ cup to 1 cup per meal.
* Keep in mind that your diet needs to be low fat, low calorie, sugar free and portion controlled for the rest of your life. This is the commitment you must make to achieve maximal weight loss.
* If you experience increased hunger in the first 10 days after surgery, drink more calorie rich drinks (i.e. Slim Fast, milk). Do NOT advance your diet prematurely as you will increase your chances of band slippage. You are on a liquid diet to help promote healing.
* If you experience excess gas make sure you are not using drinking straws as it promotes swallowing excessive air. Other possible causes of gas include Lactose Intolerance, high consumption of sugar free foods, excess dietary fiber, and calcium carbonate. Make the appropriate changes if needed. For example, try Dairy Care, lactaid milk or soy milk if you are lactose intolerant. Talk to the MD or RD about products such as GasX, Mylanta or Beano to help reduce gas.
* If you experience constipation, increase fluid, dietary fiber and physical activity as medically feasible. Fiber rich foods include beans, oatmeal, fruits, whole grain breads and high fiber cereals. Add fiber slowly into your diet to avoid stomach upset. Increase your fluid intake as you increase your fiber intake. Talk to the MD or RD about products such as Phillip’s Milk of Magnesia, Colace or Benefiber to help with constipation.
* It is recommended that you keep a food journal. This will help you keep track of your eating habits. Bring the food journal to your nutrition follow up visits to review your progress with the nutritionist.
* It is very common to hit a weight loss plateau (weight loss stops for a period of time). Most people will experience one or more plateaus during their weight loss journey. This is NORMAL!!! Your body is becoming more adjusted to consuming fewer calories. At this time review your diet and your eating behaviors. Are you eating protein first? Are you limiting your fats and starches? Are you consuming “soft calorie” foods (i.e. ice cream)? Are you drinking at your meals? Review the original guidelines in this packet and adhere to them. Meet with your nutritionist to review your diet.
* When you come in for an adjustment (a “fill”) you will be placed on a FULL LIQUID DIET for the first 2 days. The following 2 days (day 3 and 4) you must be on a mushy/pureed diet. You may resume regular foods on the 5th day after your fill.
TOP TIPS FOR SUCCESS
Chew food well (until it is pureed).
-Try cutting up food into small pieces (the size of a pencil eraser).
-Liquefy food in mouth before swallowing (chew food 15 times before you swallow).
-Put your fork down between bites (count to 60 before you take another bite).
-Try using cocktail forks or baby utensils to help take small bites.
Watch your portion sizes at meals.
-The less food you put in front of you, the less you will eat.
-Use saucer plate for meals or buy small Tupperware for portion control.
ü Stop eating when you feel comfortable satisfied.
-It takes 20 minutes for your brain to identify that your stomach is full. When you feel a pressure in your upper stomach area, this is your new full feeling. If it is painful, you probably took one too many bites! DO NOT OVEREAT!
-Eat slowly to recognize this feeling.
-Keep a timer on your table when eating. Set it for 20 minutes. This visual will be a constant reminder to SLOW DOWN!
Only eat when hungry.
Drink adequate fluids to prevent dehydration.
-Aim for 48-64 oz (6-8 cups) of fluid a day.
-Do not drink and eat at the same time. Stop drinking 5 minutes before your meal then wait 20 minutes after a meal to resume drinking.
-For the first week post-op your stomach is swollen and it may take 30-60 minutes to drink a cup of liquid. Keep sipping all day to help prevent dehydration, it gets easier as the weeks pass. Soon it will only take 5-15 minutes to finish a cup. Beverages must be sipped, no gulping!
-Try sippy cups or sports top water bottle to slow you down, keep fluids with you all day long and keep sipping.
-Avoid setting a glass at your place setting. It is too tempting to drink if there is a beverage at your meal.
-Increase your fluid intake if any of the following signs are present: dark urine, headache, dizziness, confusion, a white coating on the tongue. And call your doctor.
Avoid carbonated beverages and beverages containing sugar.
-The bubbles may cause irritation and gas.
-Choose sugar free/calorie free, non carbonated drinks such as: Crystal Light, Fruit 2O, Diet Snapple, Light Minute Maid, etc…
-Limit caffeinated beverages to no more than 16 oz a day.
-Caffeine can irritate the lining of the stomach and may increase your risk of developing ulcers after surgery.
-Wean off carbonated and caffeinated beverages before surgery to help prevent withdrawals.
ü Avoid alcohol beverages.
Alcohol, beer and wine, in excess, can cause weight gain and result in poor nutrition since they are high in calories and low in nutrients.
Read food labels.
-Food choices should be no sugar added and low in fat.
-These poor food choices can slow down the rate of weight loss and may even cause weight regain.
-Avoid concentrated sugar. (It’s high in calories and leaves you hungry for more!)
-Keep sugar out of the first 3 ingredients no the food label.
-The following ingredients are also known as sugar and commonly found on food labels: dextrose, high fructose corn syrup, glucose, sucrose molasses and honey.
-Artificial sweeteners such as NutraSweet/Equal, saccharine/Sweet & Low and sucralose/Splenda are acceptable to use.
-Watch out for foods containing sugar alcohol such as sorbitol. Large amount of sugar alcohol found in sugar-free candies, cookies, or ice cream may lead to cramping, abdominal pain, excess gas or diarrhea.
Limit high fat foods.
Low fat is 3 grams or less per serving on a food label.
Protein is the most important nutrient you need to consume after surgery.
-You need at least 60-80 grams of protein a day.
-Protein should be consumed first at each meal, then vegetables and fruits, then “whole” grains.
-You may drink a protein supplement if you are not able to consume adequate amounts of protein.
-Look for drinks made with whey protein isolate (this is absorbed well).
Strive for a protein shake with at least 20 grams of protein per serving.
-Mix with skim or 1% milk for an additional 8 grams of protein per serving.
-Aim for a product with less than 3 grams of sugar per serving.
-Aim for at least 30 minutes every day.
-Exercise helps maintain long term weight loss.
-The first 6 weeks, walking should be used as the primary exercise.
-After 6 weeks, try introducing strength exercises.-Always speak to your
doctor if you have never exercised.