Microsoft word - lap band diet progression-new08.doc

“Lap Band”
(Bring this booklet to your nutrition appointments and to the hospital)

Your Nutritionist: ________________________________

Telephone Number:
(413) 794-7020

This booklet has been designed to teach you the dietary guidelines you must follow after having
lap band surgery. Surgery is just the first step in the treatment of obesity. Your commitment to
a healthy diet and a daily exercise program will determine how well you lose weight and
maintain your weight loss.
The lap band diet progresses through five stages of eating. You must follow this diet
progression carefully and keep all of your appointments with the nutritionist and the surgeon.
Patients who keep their regular appointments have the most success with weight loss.

Behavior modification techniques may help you increase your long-term success after weight
loss surgery.
Keep a positive attitude
• Permanent weight loss requires a change in food attitudes. Stay positive about Make food less visible in your home
• Store all food out of sight. Try to keep food off of the counters. • When serving meals, keep pots or serving platters on, or near, the stove - not • Store leftovers immediately after meals. Change your food shopping habits
• Avoid grocery shopping when you are feeling hungry. • Make a shopping list and stick to it. • Shop the walls. Avoid temptation by avoiding the aisles. Most healthy foods- fruits, vegetables, fresh fish, meat, dairy products- are found along the walls of the store. • Avoid buying unhealthy food items for other people that you may be tempted Eat slowly
• Allow 20-30 minutes for mealtimes. Right after your surgery, you may need up • Take small bites and chew food to a smooth, pudding-like consistency. • Set your utensils down in between bites. Portions are important
• Weigh and measure all portions before eating until you learn what a healthy • Put all extra food away before eating. • Use small dishes and utensils. • Cook “just enough.”
Make eating an isolated activity

• Choose a spot at home just for eating. • Make a rule to sit whenever you eat a meal or snack. • Avoid mindless eating, including eating while watching TV or working on the Plan ahead
• Plan what and how much you will be having for meals and snacks. • Use a cooler or insulated bag to carry food and drinks when you will be at work or “on the go” for periods of three hours or more. Avoid grazing
• After lap band surgery it is still possible to overeat and gain weight by eating or drinking high calorie foods throughout the day. This is called “grazing”. • Avoid nibbling and too-frequent snacking. • Your daily intake should include three small meals and two to three small, Try activities that you can do instead of eating
• If you are feeling upset, anxious or depressed, listen to music, talk to a friend, write a letter or journal entry, take a shower, go for a walk, or try yoga, meditation or another form of relaxation. • Make a list of activities you like to do or would like to try that don’t involve food. Vitamins are important
• Take all the vitamins and minerals your nutritionist and surgeon have recommended. You will not be able to meet your nutrition needs with just food. Physical Activity
Your weight is a result of the balance between the foods you eat and the amount of
calories your body burns in physical activity. As you lose weight after lap band surgery,
you may find it much easier to get around. Take advantage of this new freedom! The
more active you are, the more quickly you will lose weight.
Ask your doctor before beginning any strenuous program, particularly in the first three
months after surgery. Try some of these suggestions to increase your physical activity.
1. Walk more. Walk the dog, go for a walk with a friend, a neighbor or the children.
2. Take the bus or car less often. 3. If you take public transportation, get off a few stops early. 4. Take the stairs instead of the elevators. 5. Park your car far away at shopping centers and walk through the parking lot. 6. Take a "walking break" at work instead of a coffee break. 7. Do some yard work, gardening, or household chores that require brisk movement. 8. During foul weather, get exercise by walking in the mall. 9. Look for easy and fun new ways of exercising with your new body! Before surgery, make a list of fun and exciting classes you might take, such as ballroom dance or water aerobics. 10. Check exercise videos out of the library and make note of some of the simpler toning exercises you could do. Plan a routine based on this. LAP BAND DIET PROGRESSION
You are usually in the hospital for one day following lap band surgery. Your diet will progress through 5 different stages over the course of the next 6 weeks. Before Surgery: What to Buy
• A few bottles of water or sugar-free, non-carbonated, non-caffeinated beverages such as Crystal Light, Fruit20, Diet Snapple • A high protein low sugar shake • Food Before Surgery: What to Bring to the Hospital
• Listerine Pocket Packets • Chewable complete multivitamin with minerals • This • If you do not like the protein shake that the hospital provides, please make arrangements to have your preferred shake brought to you from home. Day of Surgery
• Once you are brought up to your room, you will be given: ice STAGE 1: WATER AND CLEAR LIQUIDS
Start: Day One Postoperatively (the first day after your surgery)
Duration: 1 day

Diet Instructions: Sip one to two ounces of sugar free, non carbonated, non-
caffeinated liquids every hour.
Clear liquids include: water, Crystal Light, sugar-free popsicles, fat free broth, decaf tea or decaf herbal tea, sugar-free jello Fluid Goal: 24 -32 ounces per day
Protein Goal: None
Important Information:
• Stop sipping as soon as you feel full.
• Use 1-ounce medicine cups for sipping your clear liquids.
• Carbonation will cause abdominal distention or discomfort.
• Juices should be avoided. They are too high in sugar and calories.
• Write down the amount of clear liquids you drink on your food record.
• Avoid using a straw when sipping.
Avoid vomiting. Vomiting can lead to band slippage.

Start: Day 2
Duration: 7 days (postoperative days 2-8)
Diet Instructions: Low sugar protein shakes – number of servings per day will be
determined by hospital dietitian. Please tell nursing staff if you are lactose intolerant.
Milk Based High Protein, Low Sugar Beverages
Note: No Sugar Added Carnation Instant Breakfast powder contains aspartame
sweeteners and the ready to drink carton contains sucralose. Some people may be
sensitive to aspartame.
Lactose Free High Protein, Low Sugar Shakes
Lactaid) must be mixed with whey protein isolate powder Fluid Goal: 56 ounces = 7 cups (8 ounces each) per day of sugar-free, non-
carbonated, non-caffeinated liquid. Your fluid intake includes protein shakes, which
should be your first goal.
Stage 2, continued
Protein goal: 70 grams or as advised by your nutritionist
Your protein goal: _______________
Protein is important to help healing and to preserve muscle mass. It may be difficult to meet your protein goal in the first week. Do your best to meet your goal. Vitamins: One chewable complete multivitamin with mineral supplement (children’s
or adult) per day or one tablespoon liquid multivitamin with minerals. Look for the word
“complete” and the USP symbol on the label.
Important Information:
• It is VERY important to stay hydrated. Sip fluids throughout the day. The color of your urine should be pale yellow to clear. • Sip all liquids slowly. Sip no more than 2 ounces every 15 minutes to stay on • Avoid gulping. It introduces air into your system and may cause gas pains. • Do not force yourself to finish fluids if you feel full. • Plan ahead and have protein shakes ready to drink. • Write down the amount of fluid you drink on your food record. • Use a thermos or chill your glasses in the freezer if you prefer your shakes cold. • Try to limit sugar alcohols. When looking at a label, they typically end in “ol”, example: mannitol, sorbitol. Sugar alcohols can cause gas, bloating, abdominal pain and diarrhea. • If you are lactose intolerant, try Lactaid drops or Lactaid milk or lactose free • Avoid using a straw when sipping.
Avoid vomiting. Vomiting can lead to band slippage.

Start: Day 9

Duration: 7 Days (postoperative days 9 – 16)
Diet Instructions: Continue drinking the amount of high protein, low sugar shakes as
advised by your nutritionist (the same as stage 2).
In addition you may add 1 or 2 small portions of the following suggested pureed and
smooth foods. Remember to stop eating at your first feeling of fullness.
• Pureed foods need to be made using a blender or food processor. The texture should be smooth, with no lumps. • If you are having trouble reaching your protein goal with protein shakes, add whey protein isolate powder or dry skim milk powder to your pureed foods. Whey protein isolate is an excellent source of protein and is tolerated by people who are lactose intolerant. • If you are constipated, try adding Benefiber to your foods.
Fluid Goal: 56 ounces or 7 cups (8 ounces each) per day of sugar free, non-
carbonated, non-caffeinated liquids. Your fluid intake includes protein shakes, which
should be your first goal. Continue to limit sugar alcohols. Remember to drink
enough fluids to maintain pale yellow to clear colored urine
• Protein
Protein Goal: 70 grams/day or as advised by your nutritionist.
Your protein goal is: ____________

Vitamins: Continue taking one chewable, complete multivitamin supplement with
minerals (children or adult) per day or one tablespoon liquid multivitamin with minerals.
STAGE 4: SOFT SOLID FOOD (pureed/diced)

Start: Day 17
Duration: 2 weeks (postoperative days 17 – 31)
Diet Instructions: This is the stage when you begin to transition from getting
your protein from shakes to getting your protein from food.
• _____ grams protein (including dairy products) • 2 vegetable servings • 2 fruit servings • 1-2 starch servings • 2 fat servings * See pages 15 to 19 for serving sizes
Fluid Goal: 56 ounces (7 cups) of sugar-free, non-carbonated, non-caffeinated liquid
Your fluid intake includes protein shakes which you may need in order to meet your
protein requirements. Drink enough fluid to maintain pale yellow to clear colored urine.
Protein Goal: 70 grams/day or as advised by your nutritionist.
Vitamins: Continue taking one complete, chewable multivitamin with minerals
supplement (children’s or adult) or one tablespoon liquid multivitamin with minerals.
Important Information:
• The soft solids (pureed/diced) stage gradually re-introduces soft food to your o It is important for you to eat all of the recommended dietary protein. • In the beginning days of Stage 4, you may find frequent, small mini-meals
and snacks are necessary in order to meet your protein goal. In time, your goal
should be 3 mini-meals and 2 to 3 healthy snacks every day.
• At first you may not be able to tolerate all of the recommended foods. Supplement with protein shakes as needed in order to meet your protein requirement. • It is important not to overstuff your pouch. Listen to your body and stop eating as Stage 4: continued
• All foods should be tender and moist. o Foods that are marinated, boiled, sautéed, and baked or microwaved with a liquid are best. Dark meat of chicken and turkey tends to be better tolerated than white meat. Do not eat fried foods. o It’s OK to add condiments such as ketchup, light or fat free mayonnaise, o Tough protein foods including red meat, hamburger, pork, lobster, o Membranes of oranges, tangerines and grapefruit because they can block o Generally, cores, skins and seeds of fruits and vegetables o Raw vegetables including salad o Popcorn, nuts, and peanut butter o Doughy breads, including bagels o Rice and pasta o Chinese • Consider starting with canned vegetables and then advance to well-cooked steamed, boiled or microwaved vegetables. • Remember that corn, peas, and potatoes count as starches rather than • Consider starting with canned fruits packed in their own juice and then advance to fruit with the skin peeled off. Watch out for seeds. Avoid canned fruits packed in light or heavy syrup. • Try flat breads, such as pita, wraps, and tortillas or whole grain crackers. Whole grain bread may be better tolerated when toasted. • Weigh food on a scale after it has been cooked to be sure you are getting • Take VERY small bites of food and chew the food well until it is smooth. • Eat slowly. Remember to make your meals last 20-30 minutes. o Baby food warmer trays or beverage warmers can be used to keep food warm while you are slowly eating your meal. • Stop eating as soon as you begin to feel full. Avoid vomiting.
• Do not drink 30 minutes before, during or 30 minutes after a meal or snack.
• Do not chew gum or suck on hard candy.
• Continue to limit foods and beverages with sugar alcohol.
• Avoid using a straw when sipping.
Stage 4: continued
What is a serving of Soft Solid (pureed/diced) food?
These are foods that must be blended in a food processor or blender, mashed or
chopped up VERY fine.
Here are some examples of foods you may try
Amount That
from each of the food groups.
Equals One
Protein (6 servings)
Flaky fish - haddock, sole, flounder, tilapia, salmon Egg, scrambled (soft and moist)/ soft boiled Dried beans-cooked (1 meat and 1 starch)
Dairy (2 servings)
Vegetables–canned or well-cooked (2 servings)
Fruits (2 servings)
Peaches (canned in juice or peeled and very soft) Pear (canned in juice or peeled and very soft) Starches (1-2 servings)
Special K cereal soaked with skim or 1% milk Fat (2 servings)
Stage 4: continued
Time Food Beverage

Start: Day 32 (one month postoperatively)
Duration: Permanent
Diet Instructions: 3 mini-meals and 2 or 3 small, healthy snacks
Fluid Goal: 56 ounces = 7 cups (8 ounces each) of sugar free, non carbonated,
non caffeinated liquid. Remember, it’s important to stay hydrated. The color of your
urine should be pale yellow to clear.
Protein Goal: 70 grams/day or as advised by your nutritionist
one complete multivitamin with mineral supplement
(children’s or adult) or one tablespoon liquid multivitamin with minerals
every day.
• Chewable or tablet forms are both acceptable. If taking a chewable supplement, advance from a children’s to an adult complete multivitamin with mineral supplement. Calcium:
• Look for a calcium citrate supplement with vitamin D. You will need 1200- • Do not take your multivitamin and calcium at the same time as they may interfere with each other’s absorption. Separate them by at least 2 or more hours. Important Information:
• Make protein intake your priority. Aim for 70 grams each day or as advised by • You may include most foods in your diet at this stage. • Continue to expand food choices, one new food at a time. • Continue to drink 56 ounces of fluids per day (7 cups). • Continue to limit foods and beverages with sugar alcohols. • Read labels. Keep sugar to 12 grams or less per serving. • Avoid grazing. Be sure to plan 3 mini meals and 2 to 3 healthy snacks everyday. • Do not drink 30 minutes before, during, or 30 minutes after a meal or snack. • Drink protein shakes, if needed, to reach your protein goal. • Avoid using a straw when sipping fluids. AFTER YOUR BAND ADJUSTMENT
Your band is typically adjusted 6 weeks after placement by injecting it with saline. It is important to advance your diet slowly after each band adjustment. Follow the Stage 2 diet for 2 days immediately after your adjustment. You should then advance to Stage 3 for 2 days, Stage 4 for 2 days and then return to Stage 5. Please refer to these stages as they are described on pages 6-13. Type of Food
Very lean Protein and Substitutes (0 grams of carbohydrate,
7 grams of protein, 0-1 grams of fat, 35 calories) Chicken, turkey, cornish hen (without skin) Cod, flounder, haddock, halibut, trout, tuna (fresh or canned in 1 oz water) Crab, lobster, scallops, shrimp, clams (fresh or canned in Pheasant (without skin), venison, buffalo, ostrich 95% fat-free luncheon meat (less than 1 gram fat per oz) egg substitutes with less than 55 calories per ½ cup Lean Protein and Substitutes (0 grams of carbohydrate, 7 grams of protein, 3
USDA Select or Choice grades of lean beef, such as round, sirloin, and flank steak, tenderloin; roast (rib, chuck, rump), steak (T-bone, porterhouse, cubed), ground round Lean pork, such as fresh ham: canned, cured, or boiled ham, Canadian bacon, tenderloin, center loin chop Chicken, turkey, (dark meat no skin), chicken (white meat with Hot dogs with 3 grams or less of fat per ounce Processed sandwich meat w/ 3 grams or less fat per ounce Peanut butter, reduced fat (caution: contains 12 grams fat) Each item on this list = 1 serving
Each serving of milk or milk products on this list contains
12 grams of carbohydrate
8 grams of protein
Each item on this list = 1 Serving
Each vegetable serving on this list contains
5 grams of carbohydrate,
2 grams of protein,
25 calories)
Vegetables contain 2-3 grams of dietary fiber. Vegetables which contain 400 mg or more of sodium per exchange are identified with a ▲symbol. Vegetables are a good source of vitamins and minerals. Fresh and frozen vegetables have more vitamins and less salt than canned vegetables. Rinsing canned vegetables under water will remove much of the salt. Unless otherwise noted, a serving size for vegetables is: ¾ ½ cup of cooked vegetables or vegetable juice or 1 cup raw vegetables Each Item on this list = 1 serving
Each item on this list contains 15 grams of carbohydrate
0 grams of protein
0 grams of fat 60 calories
Fresh, frozen, and dried fruits have about 2 grams of fiber per exchange. Fruits that have 3 or more grams of fiber per exchange have a *symbol. Use fresh fruits, frozen fruits or canned fruits without added sugar. Limit fruit juice to no more than 1 serving per day. FRESH, FROZEN AND UNSWEETENED
Each item on this list = 1 serving
Each item on this list contains approximately
15 grams of carbohydrate, 3 grams of protein, 0-1 grams of fat, 80 calories
Whole grain products average about 2 grams of fiber per serving. Those foods that contain 3 or more grams of fiber per serving are identified with the fiber symbol *. DRIED BEANS/PEAS/LENTILS
(count as 2 starch plus 1 lean meat) *Beans and peas-cooked (kidney, white, split, blackeye, lentils) *Broad beans, garbanzo, navy, CEREALS/GRAINS/PASTA
(such as Bran Buds, All Bran *Bran Cereals, flaked 2 ½ Tbsp CRACKERS/SNACKS
Each serving on the fat list contains:
5 grams of fat
45 calories
The foods on the fat list contain mostly fat, although some items may also contain a small amount of protein. All fats are high in calories and should be carefully measured. Fats which contain 400 mg or more of sodium per exchange are identified with a ▲symbol. UNSATURATED FATS
type, reduced calorie) Salad dressing (oil varieties) COMMON PROBLEMS AND SOLUTIONS
The following guidelines are for your reference in case you experience any problems.
Please be sure to keep your medical team informed of any problems you may be
experiencing. It may help to keep a record of anything unusual that occurs and what
you did to correct it.
¾ Be sure to drink plenty of water (56 ounces per day- 7 cups) ¾ 1 tablespoon Milk of Magnesia ¾ Stay active ¾ After the first month: Benefiber or Sugar-free Metamucil ¾ Increase your fiber intake through fruits, vegetables and whole grains. Be sure to follow the dietary instructions of the stage you are in as some high fiber foods may not be good choices for your current stage.
¾ Go back to an earlier stage that you can tolerate. Try clear liquids for 24 hours. ¾ Chew food thoroughly ¾ Eat slowly ¾ Measure out portion sizes ¾ Make sure foods are moist ¾ Avoid eating and drinking at the same time ¾ If these suggestions do not work, or you vomit bright red or dark brown liquid, ¾ Do not over eat ¾ Drink plenty of fluids ¾ Chew food thoroughly ¾ Eat slowly ¾ Avoid carbonated beverages ¾ Avoid foods that you cannot tolerate
Stomach bloating after eating
¾ Do not overeat ¾ Do not drink fluids with meals ¾ Avoid carbonated beverages ¾ Stay active ¾ Do not use a straw
Can not tolerate dairy products
¾ Try Lactaid ® milk, tablets or drops. These are available at your local pharmacy. ¾ Yogurt may be better tolerated than milk because some of the lactose is already

Baystate Health System
¾ Eat slowly ¾ Do not overeat ¾ Do not drink fluids with meals ¾ Avoid high sugar, high fat and spicy foods ¾ Limit the amount of sugar free products (like sugar free candies). These products may contain sugar alcohols such as sorbitol and mannitol that can cause diarrhea.
Dizzy or headache
¾ Drink plenty of water ¾ Add salt to your foods ¾ Drink regular bouillon ¾ Be sure you are eating enough food ¾ If you take any prescription medications, call your doctor
Sudden light headedness
¾ Eat on a regular schedule ¾ Do not skip meals ¾ Be sure you are eating enough food ¾ If you take any prescription medications, call your doctor
Tired and weak
¾ Drink plenty of fluid ¾ Limit caffeine ¾ Sleep on a regular schedule ¾ Stay active ¾ Check to be sure you are getting enough protein ¾ Be sure to take your vitamins
¾ Limit caffeine and spicy foods ¾ Be sure you are taking your PPI (reflux or heartburn medication) such as Mylanta, Prilosec OTC, Pepsid AC, Nexium or Prevacid ¾ Avoid foods that are too hot or too cold ¾ Check the side effects of any medications you are taking
Leg cramps
¾ Eat a well balanced diet ¾ Take your multivitamin every day ¾ Stay active ¾ If the problem persists or becomes severe, please call your doctor immediately
Excessive hair loss
¾ Eat a well balanced diet with adequate protein as determined by your nutritionist ¾ Take your multivitamins with minerals daily Wound infection
¾ Call the doctor immediately for a temperature of 101 degrees or higher, and/or if pain, redness, foul smelling discharge or swelling develops
Very slow weight loss
¾ Be sure to keep a food record. Your dietitian will discuss this with you. ¾ Avoid high fat foods ¾ Avoid high calorie beverages ¾ Increase activity/exercise as tolerated
Extreme hunger
¾ Keep a food record. Your dietitian will discuss this with you.
Excessive weight loss
¾ Keep a food record. Your dietitian will discuss this with you. ¾ Discuss the weight loss with your doctor ¾ Be sure you are taking in enough calories Chest or shoulder pain
¾ Call doctor immediately, as this could be a sign of band slippage or eruption.


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