Post-Operative Diet Stages – Gastric Band

The gastric band is positioned to create a small pouch stomach with a small capacity. Adherence to a post-operative diet is crucial to give adequate time for healing. The time immediately following surgery is to allow scar tissue to form around the band that has been placed. This healing process ensures correct positioning.

The band does limit the amount of food the stomach pouch can hold, but the patient is still in control of what kinds of foods are consumed. Eating improper food during the post-op period can cause damage. The stomach muscles during digestion squeeze and churn to break down food during the process. These actions place stress and pressure on the band and sutures placed during surgery.

Starts day of surgery and should last 5-7 days

For 5-7 days after Gastric Band surgery, you will need to follow a clear liquid diet. The purpose of this phase is to allow for healing time and to stay hydrated. Dehydration is the most common reason for hospital readmission, so consuming at least 48oz a day is very important. During this phase, you should drink about 1 teaspoon at a time, using a measuring spoon or the screw cap of a water bottle. Wait 60 seconds between each sip. It is important to drink slow, small sips. It is important to get in at least 2oz every hour.

Drink very slowly and refrain from gulping (“Sips not gulps”). Gradually increase your intake of liquids to 4 to 8 ounces every hour. Sip on liquids throughout the day to stay hydrated and make sure you begin drinking fluids as soon as you wake up in the morning: this will ensure that you have enough time in the day to get all of your fluids in. It is common to find yourself able to increase fluid intake over time. Find fluids that are easily tolerated by your stomach pouch. Playing with temperature may be beneficial in preventing discomfort. Pay attention to signs of dehydration such as headaches, dizziness, nausea, lethargy, and concentrated (dark) urine. Drinks with electrolytes such as Gatorade Zero will be beneficial during this time.

Goal: Stay hydrated – you want to consume a minimum of 48 oz of fluids, optimal goal 64 oz. by sipping small sips 4-8 oz. of water per hour. Learn more about dehydration here.

• The clear diet begins immediately after Gastric Band surgery
• You MUST sip VERY SMALL amounts of fluid ALL DAY
• Avoid hot or cold liquids – room temperature or warm liquids will be more soothing and help to relax the stomach muscles

Important: You do not weigh your fluids, you measure by volume. You can have as many fluids as your body wants. Fluids will not stretch your stomach, or cause harm. This is a sample of the optimal fluids you should be getting (64oz).

Starts 5-7 days after surgery and can last up to 14 days

This stage in your diet allows a broad range of liquids and protein supplements after your Gastric Band surgery. The goal of this phase is to consume 60-90g of protein. Protein will help to prevent hair loss, maintain muscle mass, and promote wound healing. Slowly easing into the different textures of foods through each stage is important. A good rule of thumb for what is allowed on this diet are high protein foods with the consistency of what can easily be strained through a straw.

Avoid all carbonated beverages (fills the stomach with gas), sugar (extra calories that fight against weight loss and may cause dumping syndrome), and coffee (it is acidic and may have problems with acid reflux after surgery. It is also a diuretic, causing you to be dehydrated).

Be sure you are prioritizing protein during this phase, all thick liquids should contain protein to prevent loss of muscle mass, hair loss, and malnutrition. Be sure to continue to aim for 68oz of clear fluids.

Starts 10-21 days after surgery and can last up to 14 days, depending on toleration

Chew all your food well to applesauce consistency. If you don’t follow these precautions, you may experience vomiting, stomach irritation, and swelling. You could also have obstruction of the small gastric pouch. If solid foods cause nausea and vomiting, go back to the liquid diet you had earlier. Then slowly add soft foods and eventually transition to solid foods. IF VOMITING AND NAUSEA PERSIST, CALL YOUR DOCTOR IMMEDIATELY.

During this phase, it is vital to stop eating as soon as a feeling of fullness registers. This sense of fullness will likely be felt more in the chest area than in the stomach area due to the gastric banding procedure. It is important to make this transition to food and to wean off of the protein shakes at this stage, as shakes do not hold in the stomach as long as foods. Protein shakes may be utilized if you are unable to consume enough foods to meet protein goals. As a part of your new life, you will want to STOP drinking 30 minutes before a meal and 30 minutes after a meal. Doing so will ensure that you are not filling up on liquids before your solid meals, and that liquids are not going to flush food out of your system too soon after eating. This will most likely cause discomfort or pain after the gastric band procedure. Be sure to continue consuming 64oz of clear fluids.

Start taking your multivitamins, calcium, iron, and probiotic (optional) daily 2-weeks post-op. Introduce one vitamin at a time, beginning with your multivitamin. Begin vitamins no sooner than 14 days post-op to prevent gastric upset. It is common to have difficulty tolerating vitamins at first. If you experience vomiting while adding in vitamins, discontinue and try again after one week. If you need guidance in this area or require vitamins please contact us to purchase our recommended vitamins designed for your specific bariatric needs. You can order them here: https://www.emergebariatrics.com/

Goal: You begin to weigh your food at this stage – Your goal is no more than 6 oz of food – 3 oz of protein always and 3 oz of other food (healthy fat, fruits, veggies, etc).

• Your goal is to work towards getting 20 grams of protein at each meal
• Add only ONE food at a time.
• The goal for the day is 48-64 oz of fluid to prevent dehydration

***THE FOLLOWING  NEEDS TO BECOME A LIFELONG HABIT*** 

• STOP drinking 30 minutes prior to eating and DO NOT drink until 30 minutes after a meal
• Chew completely and slowly
• Eat 4-6 small meals a day
• Protein intake needs to be approximately 60-90 grams per day

This phase begins 21 days or later after the gastric band procedure and continues long-term

Goal: 5-6 oz of food per meal by weight, 3 oz of protein (20 grams), 1 tablespoon of healthy fat, 2 oz to play with. 

Many patients are ready for a solid diet at this phase of their recovery. Following this way of eating should be a lifelong change. Each will differ in the foods they can tolerate but the standards for healthy eating habits following a gastric banding procedure include:

• Continue to eat slowly and stop as soon as you feel full. Eating too quickly with a band in place can result in a blockage, pain, or vomiting.
• Do not drink at mealtimes – Avoid fluids half an hour before meals and for one hour afterward.
• Continue to focus on protein-rich foods

At each meal, you want to have at least three ounces of protein. Prioritizing your protein is vital to maintain adequate nutrition and muscle mass. In the beginning, mentally identify your protein source. You will find it is easier for non-protein foods to go down, so you may gravitate to choosing non-protein foods. You want to train yourself right at the beginning to eat protein. Eat three bites of protein to every one bite of something else.

Difficult to Tolerate:

Some foods have difficulty passing through the opening of the stoma and may cause a blockage. Some foods that may cause problems include: :

• Dry, tough foods like steak and sometimes chicken and shrimp
• Sticky foods like pasta, rice, and bread (You may try toast after 3-4 months)
• Peanut butter
• Gum. If you swallow gum, it may cause a blockage which will likely need medical intervention
• Crunch foods. Popcorn, nuts, coconut, and raw vegetables are hard to break down adequately in the mouth. Try raw vegetables again in 3 to 4 months.
• High-fat foods. Any greasy or fried foods may upset the stomach.
• Foods with skins, peels, or husks like corn, fruit, and seeds.

Recommended Solid Foods: 

Eat protein first. Make sure you have three ounces of protein at each meal. Add three ounces of healthy fats, fruits, vegetables, or starches if you can tolerate them. Pay close attention to how you feel about the introduction of new foods.

Best Tolerated:

• Fish
• Shrimp
• Eggs
• Chicken
• Tofu
• Meatless products
• Beans
• Cottage cheese
• Low-sugar Greek yogurt
• Fresh or frozen cooked vegetables, like green beans, carrots, sweet potatoes, and squash
• Fresh fruit, peeled with no skin
• Canned fruit in water or natural juice that has been drained and rinsed

STARCHES: There are two types of starches: whole grains and simple sugars. Focus on eating whole grains, such as:

• Ezekiel bread
• Crackers
• Oatmeal
• Sweet potatoes
• Quinoa

Minimize simple, refined grains, like candy, white rice, pasta, cereals, and processed sugars, including cookies, cakes, and pastries. Additionally “gummy” textured food such as bread and traditional pasta is not tolerated well and can cause blockages. You want to limit the amount of starch you have at each meal to one or two ounces. Be sure that you only eat starch with your protein. Starches will fill up your stomach, leaving little to no room for healthy proteins and essential fats.

OILS AND ESSENTIAL FATS: It is important to include essential fats in your daily meal plan to prevent deficiencies. Examples of healthy fats are: 

• Avocado 
• Olives 
• A variety of nuts 
• Oils: olive, grapeseed, or avocado

Fats to Minimize: 

• Fried foods 
• Saturated fats, like bacon, sausage, pepperoni, salami, and bologna 
• Mayonnaise/Miracle Whip 
• Store-bought salad dressings 
• Sour cream 
• Margarine

Important Reminders after Gastric Band: Remember to eat slowly. Cut your food into dime-sized bites. Chew each bite thoroughly, at least 25 times, before swallowing. Do not drink any liquids 1⁄2 hour before you eat and during your solid meal. Do not drink any liquids for a 1⁄2 hour after your meal. Liquids will pass through your new stomach pouch quickly and will not make you feel full. Consuming only solids at each meal will give you the proper feeling of fullness (satiety) while limiting the amount you eat. Take at least 20 minutes to eat your meal.

Focus on: 

• Low-fat cheese (any cheese other than American or Velveeta)
• All Dried/Canned Beans: kidney, lentil, split pea, pinto, black, etc
• Lean Meats: fish, tuna, chicken, turkey, pork loin. Make sure all meats are moist
• Canned fruit in natural juices or soft fresh fruit (peaches, banana, berries, etc)
• Cooked or non-fibrous raw vegetables
• Healthy Fats: avocado, nuts, oils, etc.

Remember: 

• Only add ONE new food at a time! 
• AVOID starchy food like white rice, pasta, bread due to the gummy texture
• Chew completely and slowly
• Protein Supplements: 60-90g
• Drink at least 6-8 cups of water and any other non-calorie, non-carbonated beverages
• Stop drinking 30 minutes prior to eating and DO NOT drink until 30 minutes after a meal
• ALL NEW FOODS NEED TO BE SOFT, COOKED, OR CANNED
• AVOID all raw fruit with skin, raw fibrous vegetables, and popcorn
• RECORD all new foods and any problems you have with these new foods in a food diary. Let your doctor know of any problems or questions you may have.
• CHEW your food very well before swallowing. The consistency of the food should be like mashed potatoes. Make sure that each bite is very small (as if you were feeding a baby) and continue to eat small amounts slowly. Eat about 2 Tablespoons over 10-15 minutes.
• CONTINUE to take your multiple vitamins, calcium supplements, iron, and B12 supplements as directed
• AVOID beverages that have alcohol or caffeine and those that are carbonated
• AVOID using a straw or chewing gum

FREQUENTLY ASKED QUESTIONS

ALCOHOL POST-OP

General guidelines if you choose to drink alcoholic beverages;

• Wait 6 months for the body to heal

• Avoid sugary and large amounts of alcohol, start very gradually….
• Never drink and drive, the absorption may be too unpredictable.
• Be aware of the caloric intake
• Avoid carbonated drinks such as beer, these may cause discomfort

Research shows that blood alcohol levels peak higher and faster and take longer to return to normal. You are consuming less food now, so alcohol will be absorbed faster. For most patients, a single drink can raise the blood alcohol level to the point of intoxication. It can also cause your blood sugar to drop which is dangerous because you can lose consciousness. Remember that alcohol is empty calories and is not a good option to maximize weight loss.

Acid Reflux

The primary symptom of acid reflux is heartburn and involves burning of the lower esophagus by stomach acids. A band adjusted too tightly or an inflamed stomach lining are common culprits related to this post-op problem with gastric banding.

Dumping Syndrome

Dumping syndrome occurs when foods leave the stomach and enter the intestine too quickly, especially if these foods are high in simple sugars or fat. Once the food is in your intestine, the intestine will pull water from other parts of your body in an attempt to dilute the concentration of sugar or fat in your digestive system; this process creates numerous symptoms. Dumping syndrome can occur while you are eating a meal or within five to ten minutes of finishing your meal.

Early signs of dumping syndrome are abdominal fullness, abdominal cramping, dizziness, weakness, cold sweats, diarrhea, and nausea. Late signs of dumping syndrome are very much like having low blood sugar and can occur 1 to 3 hours after the original dumping episode. You may feel shaky, weak, or nauseous.

To prevent dumping syndrome, you will need to avoid eating too much simple sugar and/or too much fat at a meal. You must also eat slowly. You may want to keep a food journal to note which foods you do well with and which foods cause issues.

Nausea & Vomiting

One of the main causes of nausea and vomiting after surgery is not following the nutrition guidelines. Any problems with nausea or vomiting should prompt the following questions and necessitates changes to avoid further pain and discomfort:

1. How long am I taking to eat and/or drink?
2. Am I eating and/or drinking slowly enough?
3. Did I drink fluids with my meal or too soon before or after the meal?
4. Am I eating more than I should?
5. Do I continue to eat after I feel satisfied?
6. Am I chewing solid foods until they resemble a pureed consistency?
7. Did I lie down too soon after my meal?
8. Did I eat hard-to-digest foods such as tough meat or untoasted bread products?
9. Did I eat foods from the next diet phase before being cleared by my physician/nutritionist?

If you vomit, do not eat solid foods. Instead, return to sugar-free, clear liquids (Phase 1). If you’ve said “yes” to any of the questions above, consume liquids until solid food is once again comfortable to eat. If vomiting persists throughout the day and/or you’ve answered “no” to all the above questions and the vomiting is not improving, call the surgical liaison or see your local medical provider.

Learn more: 13 Ways to Stop Nausea and Vomiting

Band Adjustments

Adjustment of the lap band that is the foundation of this procedure will likely be required intermittently. These changes are sometimes referred to as “fills.” Your band will need to be tightened if weight loss stops or if increased hunger despite regular meals becomes consistent. Adjustments are determined on a very individual basis. Several factors can determine what kind of an adjustment is needed including patient weight and adaptation by the stomach and esophagus to the banding.

DIARRHEA

After surgery, diarrhea is related to fatty acids passing directly into the colon. These fatty acids would normally have been absorbed in the small intestine. Once in the colon, they induce irritation. Diarrhea can also be produced by relatively undigested food passing rapidly through the gastrointestinal tract. A third contributing factor is sorbitol, found in fruits, berries, and also used as an artificial sweetener. Sorbitol is not well absorbed in the GI tract, and when in the colon, it is fermented.

Reducing the amount of fat will usually have a direct beneficial effect on the number and quality of bowel movements a patient may have after the lap band has been placed. Management of diarrhea (provided there is no identifiable pathologic etiology or dietary factor) may be varied. A dose of Imodium at bedtime can decrease the number of early morning bowel movements. If beneficial, some patients may stay on a maintenance dose of Imodium® or Lomotil® for long-term control over these symptoms. Many patients will benefit from a course of probiotics after bariatric surgery. 50 billion CFU or more is recommended, however, the higher this number, the better.

LACTOSE INTOLERANCE

Lactose intolerance is the inability to digest significant amounts of lactose, the major sugar found in milk. Lactose intolerance is caused by a shortage of the enzyme lactase, which is produced by the cells that line the small intestine. Common symptoms of lactose intolerance, which range from mild to severe, include nausea, cramps, bloating, gas, and diarrhea. Symptoms begin about 30 minutes to 2 hours after eating or drinking foods containing lactose.

The level of dietary control needed with lactose intolerance depends on how much lactose a person’s body can handle. To avoid symptoms associated with lactose intolerance, use lactose-free low-fat milk or unsweetened non-dairy milk (almond, soy, rice, etc.). You may also take over-the-counter Lactaid® supplements with a meal containing dairy foods (taken as directed by the manufacturer).

Learn more: Can Lactose Intolerance Occur After Bariatric Surgery?

Related Resources

• Lap Band Removal – Losing Weight with Lap Band Revision Surgery
• Complications & Risks of Gastric Banding
• Cost of Gastric Banding Surgery
• Post-Operative Guide to Lap-Band
• Pre-Op Diet – Gastric Banding
• Mexico Bariatric Center Lap Band Success Stories
• Recovery after Gastric Band
• Gastric Banding Fills, Adjustments Guide
• Is Transitioning from Lap Band to Sleeve or Bypass Beneficial?
• Bariatric-Friendly Recipes: Cookbook On The Go