Immediately after surgery*
A patient can start taking low sugar clear liquids 2 hours after surgery. Initially this should be water and ice chips, but any liquid that is not opaque (i.e. can be seen through) and low sugar is allowed. These include diet iced tea, low calorie sport drinks (e.g. Propel Water), light soups (e.g. broth), sugar free Popsicles, sugar free Jell-O, etc. There is no limit on the volume of clear liquids that are allowed. However, all liquids should be taken slowly. Avoid gulping, as this increases the amount of swallowed air – and subsequent belching – which can be uncomfortable.
Post-op Days 1-7
Follow the general guidelines given above. As the first week post-op progresses larger volumes can be consumed. Liquids that are hot or cold may be better tolerated. Read labels and avoid liquids with too many calories.
Post-op Weeks 2-3(Post-op Days 8-21)
If there are no prior problems, the patient may progress to the soft low sugar, low fat diet for weeks 2 and 3. This does not mean pureed food – a better limit on the consistency is that the food should be able to be mashed up easily with a regular fork. Foods that do not pass this test (e.g. chicken or bread) need to be avoided. These meals should also be low in sugar (less than 4-5 grams per meal) and low in fat (less than 6 grams). It is essential to read labels, not only for overall carbohydrate and fat content, but also for specific ingredients. When sugar or high fructose corn syrup is one of the first ingredients, that food product should be avoided. Similarly, saturated and trans-fats should not be consumed. Protein on the other hand should be emphasized with a target of 12-20 grams per meal. Soft foods rich in protein include baked fish, tuna, lean ground beef, and legumes (e.g. beans, lentils). It is possible that the patient may feel some restriction (fullness) on the soft diet. Stop eating, and begin again slowly several hours later. Vomiting is to be avoided as it is likely the main cause of a Lap Band slip or prolapse. This may be more likely soon after surgery as the scar capsule has not fully formed around the band.
After Post-op Week 3 (>21 days Post-op)
By the fourth week post-op the patient should start the solid low sugar, low fat diet. This includes all solid foods as long as they are low sugar and low fat (see above). The objective is 3 meals a day with approximately 4-5 grams of carbohydrate, 6 grams of fat and 12-20 grams of protein for each meal. Food should be chewed well, but not to the level of puree. It is also essential for the patient to eat slowly as this will help prevent vomiting if there is restriction.
After Lap Band Adjustments
There may be a small amount of swelling several hours after a gastric band adjustment. As a result the channel through the band may become even more narrow. Because of this it is recommended that the patient return to a low sugar clear liquid diet for 24 hours after adjustment. Intake should progress from soft to solid low sugar-low fat foods over the next 24 hours.
How to Eat with an Adjustable Gastric Band
Remember that the adjustable gastric band is placed near the top (inlet) of the stomach to create a small pouch about the size of a large egg. It is key to understand that adjusting the band has no effect on the size of this pouch – it only controls how fast the pouch empties. Therefore, 2 important things need to happen for the band to work properly. First, the patient must fill the small pouch with solid food until it is slightly stretched. This will produce a full feeling – even if the rest of the stomach is empty. This should be the goal of a meal, to bring on the “full feeling” with very little solid food. Second, the band should be tightened until the small pouch empties very slowly. It would be of little use if the patient filled the pouch, only to have it empty out in a few minutes. He/she would lose the full feeling and not be able to control his/her hunger for very long. If the band is adjusted properly the pouch will empty out slowly – over 2-3 hours – and the “full feeling” will be present much longer. This sensation, which is known as intrameal satiety, allows the patient to exert control over hunger and avoid intake between meals.
Several important points must be kept in mind. The patient can not put too much food into the pouch too fast. This will result in discomfort or vomiting – and, therefore, increase the risk of slippage or prolapse. Overstuffing the pouch does not mean the band is too tight, it usually means that the patient was eating too fast. This unpleasant problem can almost be eliminated if the patient eats slowly and pays attention to what he/she is feeling while eating.
Liquids need special consideration because they will go right through the band channel, even if the band has been made very tight. Liquids do not fill the pouch for long and do not provide intrameal satiety. As a result, they are not very helpful in the gastric band process. Liquid calories are the downfall of the adjustable gastric band. Juices, milk, ice cream, latte, Gatorade, sodas, soups etc. should be avoided. Even such “healthy” choices as protein shakes and fortified vitamin drinks should be avoided as they have too many calories. Liquids should be no calorie or low calorie such as: water, iced tea (artificial sweetener), coffee (artificial sweetener), crystal lite, low calorie sport waters (e.g. Propel), and diet sodas (after 30 days). Look at labels. Any liquids should be less than 5-10 calories per serving. Protein supplementation should be in powder form (whey protein) and put on solid food.
Finally, the order in which a patient eats and drinks with an adjustable gastric band is important. If he/she filled the pouch with solid food and felt full, but then drank a large quantity of water, the water would act to flush the food out of the pouch. This would eliminate the full feeling and the patient would have a harder time suppressing hunger in-between meals. So, it is preferable that the patient have liquids first during a meal. He/she can have as much no or low calories liquid as desired to reduce any feeling of thirst. The patient will only need to wait 1 minute or so for the liquids to clear the pouch and then he/she can proceed to fill the pouch with solid food. This strategy works the best to create the necessary intra-meal satiety to help the patient control his/her hunger between meals.
If these guidelines are followed, the best effect will be achieved with an adjustable gastric band, and the patient will get the most weight loss from the surgery.*