We give special attention both before and after surgery in order to decrease risks during surgery as well as aid you in success following your procedure.

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Prior to surgery your surgeon may require you to participate in a liquid diet for two week prior to your surgery. We call this diet the Liver Diet. This diet helps the liver shed large stores of fat that we all store on our livers. By decreasing this fat storage in the liver, it aids the surgeon by increasing the surgical field that otherwise might be hindered by large amounts of fat.

Twenty-four hours before your surgery, you will be on a clear liquid diet. Clear liquids include broth, tea, bouillon, Jell-o, popsicles, and water. This allows your stomach to empty of any solids before your surgery.

There are specific diets for patients post-operatively. Your diet will be discussed in detail during your pre-operative educational class. We provide you with this diet several weeks before your surgery so you may review and ask any questions that you may have. We will further review diet choices and general nutrition education at follow up visits and support groups.

We also utilize the services of area nutritionist who have experience working with bariatric surgical patients to offer nutritional evaluations and counseling for patients who request more intensive education.

Gastric Banding Surgery Post-Operative Diet

WEEK 1
LIQUIDS ONLY!

By consuming liquids only, you will prevent vomiting, or overfilling and stretching of your new stomach pouch. This gives your band a chance to encapsulate around the stomach wall, thereby decreasing the chances of your band slipping out of position later on.

Week 1	Eating Behaviors	Food Choices
	Consume a low-fat, low-sugar, clear liquid diet for the first week: Sip liquids at meal Drink water or other non-calorie, non-carbonated beverages between meals	Clear Liquid diet choices: Clear broth (skimmed of fat) Sugar-free Kool-Aid, HiC, Popsicles, Jell-O Gatorade Fruit juices diluted with water

DO’s	DON’Ts
Sip liquids slowly Choose liquids which are low in fat and calories Drink plenty of water or non-calorie beverages between meals Avoid alcohol and carbonated beverages	Eat any solid foods or soups containing solids such as meats or breads Gulp any liquids

WEEK 2
FULL LIQUIDS!

Weeks 2	Eating Behaviors	Food Choices
	Consume a low-fat, low-sugar, all liquid diet for the first 3 weeks: Sip liquids at each meal Drink water or other non-calorie, non-carbonated beverages between meals	Liquid diet choices: Nonfat (skim) milk Carnation Instant Beverage (without added sugar) Low-fat creamy (strained) soup Low-fat Low-sugar yogurt, pudding or custard Commercially prepared protein drinks Fruit juices diluted with water

The fluids listed above may travel through the banded area rather rapidly. You may not feel full after a liquid meal. This is expected. Remember, the primary concern in the first month is not so much weight loss as it is allowing you to heal, allowing the band to encapsulate around the stomach, and preparing you to start progressing your diet to thicker, denser foods.

DO’s	DON’Ts
Sip liquids slowly Choose liquids which are low in fat and calories Drink plenty of water or non-calorie beverages between meals Avoid alcohol and carbonated beverages	Eat any solid foods or soups containing solids such as meats or breads Soups made with cream Puddings or custards unless are low-fat and low-calorie Gulp any liquids

WEEK 3
Soft food!

During week 3, you should eat foods that are moist and mushy than can be crushed with your fork.

Weeks 3	Eating Behaviors	Food Choices
	Slowly consume soft consistency protein food in small amounts 3 times a day Drink water or other non-caloric, non-carbonated beverages up to 15 minutes before a meal and 1 hour after a meal	Soft protein food choices: Low-fat cheese (cottage cheese, American cheese) Eggs or egg substitutes Egg, chicken or tuna salad Soy products Beans Soft carbohydrate food choices: Hot cereal or cold “soggy” cereal Mashed potatoes Fruit without the skin (canned fruit, apple sauce or bananas) Soft well-cooked vegetables (e.g., spinach, squash)

Remember to eat slowly and try very small portions to start. You may notice a feeling of fullness after eating small portions of soft foods.

DO’s	DON’Ts
Eat small portions very slowly Have protein at every meal Drink plenty of no-calorie beverages between meals	Eat any fibrous foods such as raw vegetables or tough meats Eat any fast foods or concentrated sweets

WEEK 4 and beyond
Solid food!

You are ready to introduce solid food into your diet. You should be experiencing satiety, a feeling of fullness and satisfaction after eating small portions of solid foods, mainly after your first adjustment.

Weeks 3	Eating Behaviors	Food Choices
	Slowly consume a small portion of protein food and vegetables 3 times a day. Space these solid meals 5 hours apart Chew all solid foods to a mushy consistency Do not drink liquids during or shortly following a meal	Solid foods, as tolerated: Fish Ground chicken and turkey (dark meat) Introduce pasta, rice and red meats at separate times to see if they are tolerated Avoid fibrous foods such as pineapple, celery and non-tender cuts of red meat Avoid meat and other foods which are dry and overcooked

Remember to eat very slowly, chew thoroughly, and take very small bites. You should spend 30-45 minutes eating at each meal. Once solids are started, you should experience a feeling of fullness. This is how you will eat permanently.

Foods that you may find difficult to tolerate are:
Tough or dry meats, Bread, Rice, and Pasta

	Go Ahead Foods	On Occasion Foods	Foods To Avoid
Vegetables	All fresh and frozen	Vegetables juice Tomato juice Canned vegetables	Deep fried vegetables Creamed vegetables Corn Asparagus stalks Celery
Fruits	Fresh fruits	Fresh juices	Canned fruits in syrup Pineapple Fruit candy Fruit punch
Proteins	Chicken or turkey, no skin White fish Tuna fish Milk, skim or 1% Egg whites or egg substitutes Low-fat cottage cheese Low-fat cheeses Yogurt, non-fat, no added sugar Beans, lentils, split peas	Lean, tender cuts of veal, pork, and beef Whole eggs	Whole milk Regular cheeses Omelets Ribs Sausage Bacon Fried chicken
Starches and Sweets	Whole grain bread Cooked cereal Brown rice Whole wheat pasta Beans, lentils, lima beans Baked potato Sweet potato Mashed potato, no fat	White bread Unsweetened ready-to-eat cereal Saltine crackers Rice cakes	Snack chips and crackers Sweetened cereal Cookies Cake Ice cream Sweetened beverages French fries

THESE ARE THE WAYS THAT PEOPLE LOSE WEIGHT AND KEEP IT OFF:
Eat three meals a day spaced five hours apart Choose foods which are high in protein and low in fat Always eat proteins first Avoid sweets and foods high in fats Limit your portion size to less than a cup per meal Avoid drinking and eating at the same time Avoid carbonated and calorie-containing beverages Drink 64 ounces of water or non-calorie, non-carbonated beverages Exercise daily

Vitamins

If you eat a balanced diet every day, you may not need a daily supplemental multi-vitamin. We recommend taking one everyday. Since most of the multi-vitamin pills are fairly large and could possible block the small opening in your stomach pouch, you will need to select either a liquid daily multivitamin-mineral supplement (e.g., liquid Centrum) or two children’s chewable vitamins (e.g., Flintstone’s) each day.

Caffeine

We don’t advise to drink any beverages containing caffeine. Caffeine tends to increase the acids in the stomach causing irritation and heartburn pain. Caffeine is a diuretic (increases urination), which will increase the loss of water, certain vitamins, and minerals such as calcium, magnesium and potassium.

Try decaffeinated beverages to replace the need.

Soft Drinks (Carbonated Beverages)

Carbonation from soft drinks can build up in the small stomach pouch and cause bloating or stomach irritation, which can be very uncomfortable. The carbonation can cause the pouch to enlarge. One year after your surgery, if you want to try soft drinks, let the soda sit in a glass with ice for few minutes so that some of the gas is released. You should only try sugar-free (diet), caffeine-free sodas.

By following the 10 Rules you can optimize your weight loss with the Band.

10 Rules

Eat 3 small meals a day Eat slowly and chew thoroughly (approximately 15-20 times a bite) Stop eating as soon as you feel full Don’t drink while you are eating Don’t eat between meals Only eat fresh food (can be frozen or canned fresh foods) Avoid fibrous food (celery, broccoli, etc.) Drink enough during the day (approximately 64 ounces) Only drink low-calorie drinks Exercise at least 30 minutes a day (when released to do so by the Surgeon)

Sleeve Gastrectomy Post- Operative Diet

Phase One

• After surgery you will not eat or drink at all until your surgeon has given the order for the Clear Liquid Diet to begin. This will be the day after your surgery.
• In the hospital, you will be given water, clear broth, diluted unsweetened apple juice, diet gelatin, or decaffeinated tea.
• Carbonated beverages are not allowed. You will not be given red fluids. (If red fluids are consumed after surgery and you vomit, it may be mistaken for blood.)
• Avoid liquids sweetened with sugar. A sugar substitute is acceptable.
• Slowly sip one ounce (2 tablespoons) of clear liquid every hour while you are awake. Do not use a straw, as this will cause air to enter your stomach, resulting in painful gas. If you are able to drink an ounce of fluid every hour without problems, then you may increase to drinking 2 ounces (¼ cup) every hour the second day. On the third and fourth days you may gradually increase your fluid intake to 4 ounces each hour. You will need to drink 48-64 ounces over the course of the day (12 to 16 hours) in order to stay adequately hydrated. You should be taking sips every 15-30 minutes.
  Avoid caffeine after surgery because it is a diuretic, and will cause loss of fluids that you need in order to stay hydrated.
• You may experience nausea during your first week. This is not unusual. Just be sure you are drinking slowly and in small amounts. Your stomach now holds only a few ounces at a time. If the pouch gets full too quickly, nausea, vomiting, and pain may result.

Suggested Liquids:

Crystal Light Herbal Tea Diet gelatin Diet Tang Diet V-8 Splash	Sugar-free Kool-Aid Broth/Consomme Ocean Spray lite juices Miso Soup Diet Snapple	Decaffeinated tea Propel Water Sugar Free popcicles Diet Twister Acqua Extra
Wyler’s Diet Lemonade Country Time Diet Lemonade Non caloric, non carbonated fruit-flavored waters

Phase Two

• You will begin the full liquid diet when you go home from the hospital. Continue for 1-2 weeks unless instructed otherwise by Weight Management.
• Take the vitamin/mineral and calcium supplements that your surgeon has prescribed for you. You will require these daily for the rest of your life.
• Choose from the list of protein supplements in order to achieve a goal intake of 60-70 grams of protein daily.
• Remember to drink slowly to prevent nausea and vomiting, and do not use a straw. Sip 2 ounces (1/4 cup) over 30 minutes. Stop as soon as you feel full, even if you have not finished what is in your glass.
• Drink 48-64 ounces of water or low-calorie beverages in between protein drinks. Avoid carbonated, caffeinated, sugar sweetened, and alcoholic beverages.

Here is a list of protein supplement drinks that you may choose from in order to satisfy the goal of 60-70 grams of protein per day:

Unjury 20 grams of protein per scoop. Yields 28 grams of protein when mixed with 8 oz skim milk. Available in unflavored, chocolate and vanilla.

www.Unjury.com Phone: 1-800-517-5111

Designer Whey Protein 17.5 grams protein per scoop. Yields 21.5 grams of protein when mixed with 4 oz (1/2 cup) skim milk. www.designerwhey.com

Ultra Pure Protein 35 grams protein per can. Premixed, available in a variety of flavors (vanilla, strawberry cream, orange creamsicle). www.sportnutrition.com

Isopure 50 grams protein per 12 oz serving. www.sportnutrition.com

Pro Complex 53 grams protein/scoop, and can be mixed with water/Crystal Light www.Pro-Aid.com

No Added Sugar Carnation Instant Breakfast 13 grams protein when mixed with 8 oz skim milk.

Pro Blend 55 27.5 grams protein. Yields 35.5 grams protein when mixed with 8 oz skim milk. www.mdlabs.com

Nectar 23 grams protein per scoop. Mix 1-2 scoops in 8 oz water. Available in a variety of flavors (Apple Ecstasy, Very Cherry Berry, Carribean Cooler.

Pure Whey 26 grams protein per scoop. Provides 34 grams of protein when mixed with 8 oz skim milk. Chocolate, Vanilla, Strawberry, Cocoa-Mocachino and Banana Scream flavors available. www.champion-nutrition.com

You may add variety and flavor to your protein supplement drinks by adding 2 drops of McCormick Imitation Extracts, or contact Vitalady.com for sugar free syrups.

Phase Three

• You will stay on a puree diet for at least 2 weeks. Starting now, you should not drink any liquids with your meals, and wait at least one hour after meals before drinking.
• All foods must be blended to a baby food consistency. Each meal should consist of no more than 4 – 8 Tablespoons of food.
• It’s a good idea to purchase measuring spoons and cups in order to learn appropriate portion size:
  1 oz = 2 Tbsp. 2 oz = 4 Tbsp. (1/4 cup) 4 oz = ½ cup 8 oz = 1 cup
• Eat on a saucer, rather than a dinner plate. Use a baby spoon to help avoid swallowing too much food at one time.
• Eat slowly. It should take 30-45 minutes to eat. Stop if you feel full. Some foods will give you a feeling of fullness faster than others.
• Eat protein first. It is very important to eat at least 60 grams of protein daily. Keep a food journal of what foods you eat, portion sizes, and the protein grams. Bring your food journal to your next appointment at Weight Management.
• Continue to drink 6-8 cups of low-calorie beverages between meals in order to stay hydrated.
• Include new foods gradually. If you experience nausea and vomiting after eating a new food, wait several days before trying it again.

Foods to Avoid:

Whole milk, sweetened condensed milk, chocolate milk, ice cream, ice milk
Regular cream soups
Soups with regular meats and vegetables
Sugar sweetened fruit
Sugar sweetened liquids, carbonated beverages, alcohol
Vegetables with skins or hulls (peas, corn)
Fruit with seeds or skin, citrus

Phase Four

• The Soft Diet phase should last approximately 2 weeks. During this phase, try to add one new food at a time. All foods should be soft enough to be cut easily with a fork.
• Eat small meals (8-12 Tablespoons) of soft food.
• Food choices should be low in fat, low in sugar, low in calories.
• Include choices from all food groups. Each group of foods provides your body with a different set of nutrients.
• Continue to take your vitamin/mineral and calcium supplements every day. Before surgery, your body was able to obtain all the necessary nutrients from the food you ate. Now, your stomach does not hold as much food. For good health, it is essential that you remember to take your vitamin/mineral and calcium supplements.
• Remember to eat protein first. 70% of each meal should be protein.
• Do not drink with your meals, and wait at least one hour after each meal before drinking.
• Remember to chew each bite very thoroughly, and eat slowly. Each meal should take 30-60 minutes

Phase IV: Regular Diet

• If you are tolerating soft foods well, you may begin adding regular foods into your diet, one at a time.

After your surgery, your stomach will only be able to hold a few ounces of food at a time. The surgery works mainly by limiting the amount of food you are able to eat.

That’s why it is so important to choose your foods carefully, and eat only foods that will supply protein, vitamins, and minerals to keep your body healthy.

It will be necessary to change your eating habits in order to avoid stomach pain, nausea, and nutritional deficiencies. Here are some important rules:

1. Eat three small meals a day. Eating snacks (foods with no nutritional value, like pretzels, chips, crackers, sweets, etc.) will prevent you from losing weight, and may even cause weight gain.
2. Each bite you take should be only the size of a dime. You may want to use chopsticks, or baby utensils. Eat from a saucer, not a dinner plate.
3. Chew each bite until it is liquid before you swallow. Otherwise, you may experience pain, nausea, and vomiting.
4. Allow at least 30 minutes to eat a meal. Put down your fork (or chopsticks) between bites.
5. Stop eating when you feel comfortably full, or satisfied. Overeating can cause nausea, vomiting, and stretching of your new stomach pouch. It can take 6-9 months for the size of the new stomach to stabilize, and you want to keep it small.
6. Do not drink with your meals. This flushes the food through the stomach, allowing you to eat more. Try to wait 30-60 minutes after the meal before you drink.
7. Drink 48-64 oz. of calorie-free liquid daily. You will have to sip throughout the day in order to meet your body’s fluid requirements. Consuming liquid calories like sweet tea, ice cream, and cappuccino can sabotage your weight loss.
8. No carbonation
9. Take a chewable or liquid multivitamin every day for the rest of your life.

Remember that your diet needs to be low-fat, low calorie, sugar-free, and portion controlled for the rest of your life.

• Avoid concentrated sugar: Don’t eat foods that list sugar, dextrose, high fructose corn syrup, corn syrup, glucose, sucrose, molasses, or honey among the first 3 ingredients on the food label. Try to limit the sugar to 15 grams or less per serving.
• Avoid high fat foods: Low fat means 3 grams or less per serving on a food label. Examples of high fat foods: potato chips, all fast food, all fried food, bacon, sausage, hot dogs, bologna, pepperoni, cream soups, alfredo sauce, donuts, cakes, cookies, ice cream.
• Meats should be baked, grilled, broiled or poached, and all food should be cooked without added fats.