Gastric band post-op eating plan
Immediately after your band has been placed, it is important to let it sit there quietly so that scar tissue can form around it, crucial to helping it fix in the correct position. If you were to eat a solid diet in the immediate post–op period, you stomach muscles squeeze and churn to break down the food and put stress and pressure on the band and any stitches holding it in position.
The band will limit how much food your stomach pouch can contain, but you are still 100% in control of what you put in your mouth, so you need to get to grips with a healthy eating plan if you are going to get the best results from your surgery. You can out–eat a band but this does seem pointless when you have put yourself through the major step of having surgery to control your obesity. Liquid calories (e.g. sugary drinks, alcohol) and melting foods such as chocolate and ice–cream are easy to eat with a band but over indulge in them and you will still be piling in the calories and you won't lose weight.
Whilst individual surgery centres do vary in their specific eating plan advice, here is general information and guidance for band patients.
The first four weeks
You will start taking sips of water the day of your operation and the following day will probably be able to take free fluids. Once you are taking fluids easily, you can progress to puree.
The most important aspect of your eating plan for the first four weeks after band insertion is to make sure all your food is pureed and that you eat it in small quantities (4–5 small meals per day). To start with, you probably won't even feel very hungry.
- The texture should be like smooth baby food (a good test is that it should pour off a spoon) and this is most easily achieved by using a food processor or hand–held blender. You can also use a potato masher for soft vegetables and potatoes and a sieve and spoon is also useful to remove lumps and pips. When you puree food, extra fluid may need to be added to get the smooth consistency. For savoury foods you might like to use packet or cook–in sauce mixes, gravy or the cooking water from your vegetables. For fruit and desserts, fruit juice will loosen the consistency.
- The size of your meals – about 100g, or 5–6 tablespoons is the correct amount. Ensure you eat this slowly and take small mouthfuls. For the main meal of the day, you might find it easier to purchase and puree a ready meal such as a Shepherds Pie or Fish Pie (potato top) and a one–person serving will usually be sufficient for two meals for you at this stage.
- Stop eating as soon as you start to feel full. Because your pouch is at the top of your stomach, the feeling of fullness you will get is different to what you are used to – it is felt more in your chest than in your stomach. Some people describe it as a tightness, some as a heaviness.
- Drink 1.5 litres of water (2 1/2 pints) every day. Take it in 100–200ml glassfuls between meals, not with your meals.
Example meals during this stage:
||One Weetabix with milk or|
A tub of yoghurt or fromage frais or
Three tablespoons of porridge or Ready Brek made up
||Smooth soup (about a cupful)or|
||Shepherd's pie or|
Fish pie or
Chicken in white sauce or
Mashed potato and cheese or
Pureed vegetables and mashed potato
|Between meal snacks (once per day)
||Custard with stewed apple or mashed banana or|
Milk pudding (e.g. rice or sago) or
Yoghurt or fromage frais
||Water (not fizzy) or|
Tea, coffee or skimmed milk or
Fruit juice or
Weeks four to six
Continue eating the same sort of food you were for the first four weeks, but it does not need to be pureed – mashing will make it the consistency of “toddler food”. It should be still fairly soft though and keep to the same small quantities and eating 4–5 times per day. Make sure you chew each small mouthful well.
After the first six weeks
You are now ready to continue on your long term eating plan. At six weeks your first band fill is usually done and you will start to feel the restriction your band is making around the top of your stomach. Remember, you are not just eating small amounts to reduce your calorie intake and lose weight, but you are aiming for a healthy nutritious eating plan as well. Each individual differs in the foods they can eat, but there are six golden eating plan rules to follow if you are dedicated to obtaining the greatest benefit from your gastric band:
- Eat three meals per day – your new pouch at the top of your stomach empties slowly throughout the day and you should be satisfied eating three meals a day without getting hungry in between meals. Beware of developing 'grazing' eating patterns of small snacks throughout the day.
- Eat healthy, solid food – soft food slips down easily and whilst this has the benefit of being less likely to block your stoma, you will likely end up eating more over the course of the day. Many soft foods are also higher in fat or carbohydrates and as a consequence you may be taking more calories than you should and your weight loss will slow down or stop. Choose solid foods without lots of sauce (e.g. small meal of chicken and vegetables) and you will eat less overall and stay full for longer.
- Eat slowly and stop as soon as you feel full – Most obese people are used to rushing their meals and as there is a time lag from stretching the wall of your stomach and telling your brain you are full, you need to be careful with this one or risk blockage, pain or vomiting. Take tiny bites (cut meat up to the size of a pencil–top rubber) and chew each piece 10–25 times. At some point you will start to feel a tightness in your chest. Stop eating and if you are hungry again a few minutes later, have a little more.
- Do not eat between meals – you should not need to eat between meals because of hunger if you are eating three sensible meals per day.
- Do not drink at meal times – Liquids speed up the passage of food through the stoma and ruin the beneficial effect of slow emptying of food from your new stomach pouch. If you have a drink immediately before your meal you may also find that your stomach is still full and you can't eat your meal. So avoid fluids half an hour before your meals, and for one hour afterwards.
- All drinks should be zero calories – As liquids do pass through your stoma so easily, calorie laden drinks, including alcohol, will simply add calories to your daily intake. Women need calcium, and this can be obtained from skimmed milk, but avoid juice, fizzy drinks (the gas can also cause considerable pain), squashes and milkshakes.
A healthy diet
There are five main food groups and a healthy diet comprises a mix of them:
- Protein foods – such as meat, fish, eggs, beans – include 2–3 60–90g (2–3oz) portions per day. You will have to particularly careful to chew meat, chicken and fish up thoroughly before you swallow – the recommended bite size is the size of a pencil–tip eraser.
- Milk and dairy – choose low–fat cheese and limit amount to 30–60g (1–2 oz). Choose skimmed milk and low fat yogurt varieties.
- Fruit and vegetables – try to have 4–5 portions per day. A small glassful of unsweetened fruit juice counts as one portion. Salads tend to be easily digested by most people with bands, and vegetables are good and filling as well as nutritious.
- Carbohydrates – bread, potatoes and cereals. For most people with properly restricted bands, this group is somewhat harder to digest so you develop an in–built mechanism to reducing your carbohydrate intake! Replace soft bread in your diet with granary or wholemeal, or crisp breads which are more easily digestible. One small portion of 60–90g (2–3oz) at each meal will be fine.
- Fats and sugary foods – use a small amount of olive oil for cooking and replace puddings with a low fat yogurt. As mentioned before, beware of the soft calorie–laden foods such as chocolate, sweets or ice cream.
Some foods are not tolerated very well after band placement, or may block the stoma and cause you to vomit. This again is very individual and some foods cause a problem for one band patient, but not the next. Vegetables and fruits that contain stringy fibres are particularly prone to be problematic.
- Asparagus – cut up very small or blend into soup
- Pineapple – juice is ok, fruit may be difficult to digest
- Rhubarb – cut up very small or puree
- Broccoli – the stalks may be problematic
- Dried fruits – will swell inside you and should be avoided
- Oranges – juice ok, flesh may be problematic
- Meat – needs to chopped very small and chewed thoroughly
Foods such as coconut, crisps and soft white bread are sticky and difficult to digest.
Nuts (such as peanuts, almonds, walnuts) and popcorn may also cause obstruction unless they are well chewed to a paste, and are probably best avoided.
For best weight loss
Limit the following foods:
- High calorie drinks (full milk, milkshakes, alcohol, fruit squashes, juice
- Cakes, biscuits and desserts
- Cereals with added sugar
- Fats and fatty foods – butter, oils, snacks foods (crisps, peanuts), chips
- Creamy soups
Multivitamins after a gastric band
You do not have altered absorption of nutrients so if you are following a healthy diet, you should not become deficient in any vitamins or minerals. You will get most of your calcium requirements if you have three portions of dairy food in your diet each day (one portion = 1/3 pt milk, a matchbox-size piece of cheese or 1 pot yogurt).
In addition, whilst you are losing weight, you might like to take one multivitamin tablet daily – choose one that can be broken up into smaller pieces to swallow so that it does not become stuck in your band stoma. Most major multivitamin brands are suitable but avoid the capsule formulations. Suggestions are: Centrum Complete A-Z (still available in the non-chewable tablet format), Sanatogen Gold A to Z, Seven Seas Multibionta and Boots Adult Multi-vitamins.
Stuck in your stomach
If you have not followed your eating plan rules, you may get a piece of food stuck in your stoma which can be quite uncomfortable. The first advice is not to panic about it, as most times it will eventually dislodge again on its own accord. To help move the food item on, try taking tiny sips of a hot drink over a period of an hour. Some people recommend that this is the one occasion that coke is good to drink as the bubbles encourage your stomach to distend and dislodge the blockage. If 24hrs has gone by and you still have something stuck and nothing else is going down (or its coming straight back up) you need to attend your hospital for a temporary de-fill of your band to ease the problem.