Lap Band Dietary Recommendations

Lap Band Dietary Recommendations

Who is eligible?

1. Presence of morbid obesity persisted for at least 5 years, defined as either:
A. Body Mass index (BMI) exceeding 40 or;
B. More than 100 lbs over one’s ideal body weight.
C. BMI greater than 35 in conjunction with one of the following:
1. Severe cardiovascular Disease.
2. Diabetes Mellitus uncontrolled.
3. Obstructive Sleep Apnea.
4. Severe Pulmonary Disease.
5. Three or more of the following risk factors:
a. Hypertension (BP > 140 mmHg systolic and /or 90 mmHg diastolic).
b. Low high-density lipoprotein cholesterol (HDL < 40 mg/dL).
c. Elevated low –density lipoprotein cholesterol (LDL > 100 mg/dL).
d. Family history of early cardiovascular disease in a first degree relative (myocardial).
(infarction at age < 50 years in a male relative or at age < 65 years in a female relative).
5. Patient has completed growth (18 years of age or documentation of completion of bone growth).

NUTRITION GUIDELINES FOR LAP-BAND PATIENTS

Lap- band surgery was developed to induce weight loss. However, some patterns must be modified simultaneously in order to achieve and maintain the desire weight loss.

1. EATING METHODS
Eat slowly and chew foods until they reach a mushy consistency!
1. Set aside 30 to 45 minutes to eat each meal.
2. Actually count the number of times you chew each bite. Aim for 30.
3. Make an EAT SLOWLY sign and place it on the table in front of you.
4. Explain to family members the reasons why you need to eat slowly so they will not urge you to eat
faster.
5. Take small bites of food. You may want to try eating with a baby spoon or chop sticks.
6. Pay attention to taste. Learn to savor each bite, noticing its flavor, texture.
7. Chew well. Ground or very soft foods may be necessary if you have dentures.

2. STOP EATING AS SOON AS YOU ARE “SATISFIED”!
Try to recognize the feeling of fullness then stop eating at once.
Indication of fullness may be:
- A feeling of pressure or fullness in the center of your abdomen just below the rib cage, feeling of nausea, pain in your shoulder area, upper chest or jaw.
• If you start vomiting, stop eating solid foods and just sip clear liquids.
If intermittent vomiting continues for more than 24 hours, contact your doctor.

The causes of vomiting are:
- Eating too fast and not chewing properly.
- Eating too much at meal.
- Drinking liquids right after eating.
- Eating foods that do not agree with you.

3. SET ASIDE THREE MEALTIMES PER DAY AND EAT SOLID FOOD AT THESE TIMES!
- The LAP-BAND system creates a small pouch that can hold about half a cup (3-4oz) of food.
- You need to learn how much your stomach pouch can hold comfortably.
4. DRINK FOUR TO SIX CUPS OF LIQUIDS PER DAY BETWEEN MEALS!
- In order to replace normal body water losses and thus prevent dehydration.
5. DO NOT DRINK WHILE YOU ARE EATING!
- You should not drink anything for at least one hour after a meal.
6. SIP BEVERAGES SLOWLY!
- Sip from a medicine cup or shot glass instead of drinking from a regular glass.
7. ELIMINATE HIGH CALORIE DRINKS!
- Avoid carbonated liquids because they could increase the size of the pouch creating discomfort.
8. DO NOT EAT BETWEEN MEALS!
9. EAT A BALANCED DIET!
- Eating foods from each of the four food groups will provide adequate amounts of protein, vitamins and minerals for your needs.
10. EXERCISE AT LEAST 30 MINUTES A DAY!
- Start with simple activities such as walking and swimming.
- Gradually increase your activity level in the course of daily living.

PROGRESSION OF THE DIET DURING HOSPITALIZATION
- After surgery, in addition to water you will first be offered clear liquids.
- In time, your diet will include blended and pureed foods.

PROGRESSION OF THE DIET AT HOME

First week after surgery
• You’ll be on a clear liquid diet.
• Clear liquids include clear broth or soup (with no vegetables no meat and not creamy),jello, fruit juice(no nectars, no pulp), water, tea, coffee, non carbonated beverages.

Second week after surgery
• You’ll continue on liquids but adding liquids that have thicker consistency such as skim milk, low-fat yogurt, cream of wheat, oatmeal, creamy soups, fruit smoothies (nothing that you will have to chew), and tomato juice.
• Begin taking protein supplements such as Soyamax, Isopure.

Third week after surgery
• In addition to pureed food such as blended meat, meat paste, liverwurst, yogurt (no berries or other types containing seeds), you may begin to add cottage cheese, sliced cheese, cheese dishes (low fat), tofu, scrambled and hardboiled egg and fish.
• You may slowly add soft canned fruits and vegetables, baked potatoes (with no skin), rice, grits, macaroni, noodles, rice cereals, etc..

Fourth to sixth week after surgery
• You may begin to add meats that are ground after cooking, such as pork, veal, chicken, turkey and beef.
• After your checkup you can begin to experiment more with food.
• Sliced meats as well as raw fruits and vegetables may be tried (chew them well).
• If you fell hungry between meals, you may sip on low-calorie drinks and flat water.
• You may substitute one meal for a protein shake.

Something to remember!!!!
- It is important that you eat food high in protein at each of your three meals and drink 1-2 cups of milk between meals.
- Protein is needed to renew of body cells.
- The recommended daily dietary allowances (RDA) for protein is:
56g/day for men
46g/day for women
You should try to eat 50-70g of protein each day.
• Recommendation for protein intake:
- Lifeway organic brand low fat kefir drink.
- Energizer shake

ENERGIZER SHAKE!

Ingredients:
6 ounces of tofu (organic, soft or “silken” packed in water, rinse and drain) or ¼ cup nonfat dry milk powder or powdered egg whites (available at Whole Foods, in the baking section, Bob’s Red Mill brand)
6 ounces organic plain low fat yogurt (Fage 0% Greek Yogurt is best for lower carbohydrates to fit in the fruit carbs.)
1 small banana
½ cup strawberries
1 cup frozen blueberries
½ cup fruit of your choice (e.g. frozen peaches, mixed berries, or cherries)
4 cups of organic unsweetened soy milk (try “Silk” or Trader Joe’s brand)
Optional –for added fiber and omega-3 essential fatty acids, stir in a Tablespoon of ground flaxseed (try Organic Bob’s Red Mill whole ground flaxseed meal) to the cup you drink, so it doesn’t get rancid, you need to drink it right away.
Directions: In a blender, put all ingredients together. If you like a thinner shake, add water and use less milk. Put the top on the blender, chop, blend, and whip. You’re all set for an energizing breakfast or snack. Add a piece of whole wheat/grain toast or a small bowl of >5 grams dietary fiber cereal with the shake for even more sustainable energy. Make this shake the night before, keep it in the blender and store it in the refrigerator. The next morning, just press whip, and you’ve got a quick and easy “on-the-go” energizer.
Serving size: 1.5 cups
Total servings: ~4
Nutrition Analysis per serving:
239 Calories, 31 grams Carbohydrates, 16 grams Protein, 6 grams Fat.


CERTAIN FOODS MAY BE DIFFICULT TO TOLERATE!
-Through trial and error you will be able to recognize your tolerance to some food items.
Some of the food items that the digestive system cannot handle as well are:
• Tough meats, especially hamburger.
• Members of oranges or grapefruit.
• Core, seeds or skins of fruits or vegetables.
• Fibrous vegetables such as corn, celery or sweet potatoes.
• Bread.
• Chili or other highly spiced foods.
• Fried food.
• Milk.

CERTAIN FOODS MUST BE AVOIDED!
Concentrated sweets- filling up on these can prevent weight loss and can replace healthier foods in your diet with high calorie, high sugary foods.
Examples to high sugar foods:
• regular soft drinks,syrops,cakes,biscuits,sweets,jams,jellies,marmalade,honey,kool aid, sugared ice tea, dried fruits, fruit drinks, canned or frozen fruits in syrup, table sugar, sugar coated cereal, candy, doughnuts, regular jell-o, sugar gum, molasses, cookies, sherbet /sorbet, regular pudding, sweetened, fruited or frozen yogurt.
Examples to high fat foods:
• Whole milk, chocolate, chocolate milk, chips, pies, pastries, ice cream.
- Alcoholic drinks such as beer, wine, liquors, port, sherry, cocktails, and champagne should also be avoided as much as possible.

!! Some goals to achieve:
• Protein:70 grams per day
• Fluids: 64 ounces per day.
• Carbohydrate<100
• Fats<25

!!!! For successful weight loss after Adjustable Gastric Banding Surgery, a change in your habits is necessary. You will not be able to lose as much weight as you like if you eat continuously or if you stretch your stomach by eating large amounts of foods at one time. You will achieve your desired weight loss only if you are willing to control what you eat and the way in which you eat it.

Is there a short cut to weight loss?

I just saw one of my teen patients today at the gym. He was telling me that his mom, dad, and good friend are doing the "Cookie Diet" now, "they are doing awesome on it, they lost ~20 pounds." "They eat 6 cookies to start their day and then have a protein and vegetables for dinner." NOW- C'MON. These are intelligent people, they really think this is the answer. Everyone who diets, wants a gimmick. They think the only way for them to get results is to have a gimmick to follow, and the only goal in their mind is to have a lower number show up on the scale. It doesn't matter if the number is reflecting muscle, organ tissue, water and some fat loss and that they won't follow it for life. They often say, I'll just do this diet for awhile to get a jump start, then I'll eat healthier and more balanced. Yeah, that's really gonna work. Nope. THE DEFINITION OF A DIET WORKING, IS THAT YOU WILL BE ABLE TO DO IT FOR LIFE. I hear it all the time, on the radio, from the people I talk to, "oh that diet worked great for me, I lost 20, 30, 40 etc. pounds, I gained half of it back when I got off of it, so I just have to go back on it, then I'll be fine."

This diet perspective that people have is warped. This mindset is way off. The real truth in regards to our weight and health, is giving our body respect, treat it with kindness. Listen to it, is it hungry, or is it just wanting to move, or is it wanting to dance, pray, sing, or talk. It's time for Americans to shape up with their mindset or ship out to their demise. Look at the stats, the obesity rate in the US is increasing in all states, according to the Centers for Disease Control and Prevention, AP, "released a report last year that found a nationwide obesity rate of 32%." Obesity costs $117 billion a year in preventable health care expenditures and "is pushing the health care system to the breaking point, according to Jim Marks, a senior vice president of the Robert Wood Johnson Foundation, a health care philanthropy group that sponsored the Trust for America's Health Study released in 2007. Mississippi ranked number one three years in a row as the fattest state in the country and Colorado is the leanest. For childhood obesity, DC is No. 1, with 22.8% of its children are overweight (great job our nation's capital) and Utah ranked last with 8.5%. What is it that they are doing differently in Colorado and Utah to be the leanest in our country? The study doesn't show that, but as a Registered Dietitian for over 13 years, I can logically deduce that in Colorado they have a beautiful environment that is conducive to exercising, when I went to a conference there, I saw everyone running around, hiking, biking, walking to go eat. The air there breathes health. And in Utah, they pray, a great way to nourish the soul and distract from the eating focus. To end, I pray that our society can focus on self-care and respect so that we set a good example for our kids, so that they can live longer than us, right now if things continue as is, they may die before us, G-d forbid.

Your Livitician, Deborah A. Klein, MS, RD

To be in charge of whether the food goes in or not.

Be TRUE and PRESENT. It's all about self-respect. We don't own our body, our body is on loan, when we die, we don't take our body with us, our soul goes with us but not our body. SO, let's focus on nourishing our soul, taking care of our soul, cause that's what lasts. My advice to those who are having a rough time, putting down the fork when your tummy is full and your cells have had enough: think before you go for another bite of food, what is it that you are truly feeling, why are you wanting that other piece of chocolate, why do you want that pint of ice cream? Are you tired, wanting some lovin', feeling deprived... When your answer to am I hungry is no, try something different, step away from the table, and start dancing, I know it sounds silly, but sing a song out loud or to yourself and start moving, "I don't need that cookie, I don't need that cookie, just dance, dance, dance, instead." It really works. Just moving gets us awake, and strengthens us to focus on other things besides food to nourish ourselves, dancing is an expression of our soul, have fun expressing.

Deborah A. Klein, MS, RD

What is the key to keep a person inspired?

I truly want to help each patient who walks into my door. But, the most frustrating part of my job is I can't help a person who isn't ready to make changes and stay focused on maintaining a healthy way of life for life. What is it, that will keep a person inspired each day to have the mindset to choose life over another mouth full?

I was just at the gym today and saw a patient of mine who was working out, awesome job, but she still hasn't reached her healthy weight, because her emotions are getting in the way of her "control" over her food. She told me she eats and eats when she is angry, lonely, and depressed. How can I help her realize that the food does not have control over her life? The food doesn't have a mind or a heart or a soul. I want to help all of you out there who feel like the food is on the throne and you want to bow down to it, and obey it by eating it no matter what your tummy is telling you. Please let me know how you are feeling out there when it comes to eating when you are not hungry?

Email me at deborah@livitician.com.

best of health,

Deborah A. Klein, MS, RD
Your Livitician

Weight loss/nutrition/diet news

Did you know that one pound of muscle burns 17 times more calories than a pound of fat? The key to make your body more of a calorie burner is to increase your muscle mass. Try to do some push ups in the am or before you go to sleep, do some tricep dips on the park bench when you're playing with the kids.

10 Tips to Healthy Eating

An article from http://www.realtime.net/

Experts agree the key to healthy eating is the time-tested advice of balance, variety and moderation. In short, that means eating a wide variety of foods without getting too many calories or too much of any one nutrient. These 10 tips can help you follow that advice while still enjoying the foods you eat.
1. Eat a variety of nutrient-rich foods. You need more than 40 different nutrients for good health, and no single food supplies them all. Your daily food selection should include bread and other whole-grain products; fruits; vegetables; dairy products; and meat, poultry, fish and other protein foods. How much you should eat depends on your calorie needs. Use the Food Guide Pyramid and the Nutrition Facts panel on food labels as handy references.
2.Enjoy plenty of whole grains, fruits and vegetables. Surveys show most Americans don't eat enough of these foods. Do you eat 6-11 servings from the bread, rice, cereal and pasta group, 3 of which should be whole grains? Do you eat 2-4 servings of fruit and 3-5 servings of vegetables? If you don't enjoy some of these at first, give them another chance. Look through cookbooks for tasty ways to prepare unfamiliar foods.
3. Maintain a healthy weight. The weight that's right for you depends on many factors including your sex, height, age and heredity. Excess body fat increases your chances for high blood pressure, heart disease, stroke, diabetes, some types of cancer and other illnesses. But being too thin can increase your risk for osteoporosis, menstrual irregularities and other health problems. If you're constantly losing and regaining weight, a registered dietitian can help you develop sensible eating habits for successful weight management. Regular exercise is also important to maintaining a healthy weight.
4. Eat moderate portions. If you keep portion sizes reasonable, it's easier to eat the foods you want and stay healthy. Did you know the recommended serving of cooked meat is 3 ounces, similar in size to a deck of playing cards? A medium piece of fruit is 1 serving and a cup of pasta equals 2 servings. A pint of ice cream contains 4 servings. Refer to the Food Guide Pyramid for information on recommended serving sizes.
5. Eat regular meals. Skipping meals can lead to out-of-control hunger, often resulting in overeating. When you're very hungry, it's also tempting to forget about good nutrition. Snacking between meals can help curb hunger, but don't eat so much that your snack becomes an entire meal.
6. Reduce, don't eliminate certain foods. Most people eat for pleasure as well as nutrition. If your favorite foods are high in fat, salt or sugar, the key is moderating how much of these foods you eat and how often you eat them.Identify major sources of these ingredients in your diet and make changes, if necessary. Adults who eat high-fat meats or whole-milk dairy products at every meal are probably eating too much fat. Use the Nutrition Facts panel on the food label to help balance your choices.Choosing skim or low-fat dairy products and lean cuts of meat such as flank steak and beef round can reduce fat intake significantly.If you love fried chicken, however, you don't have to give it up. Just eat it less often. When dining out, share it with a friend, ask for a take-home bag or a smaller portion.
7. Balance your food choices over time. Not every food has to be "perfect." When eating a food high in fat, salt or sugar, select other foods that are low in these ingredients. If you miss out on any food group one day, make up for it the next. Your food choices over several days should fit together into a healthy pattern.
8. Know your diet pitfalls. To improve your eating habits, you first have to know what's wrong with them. Write down everything you eat for three days. Then check your list according to the rest of these tips. Do you add a lot of butter, creamy sauces or salad dressings? Rather than eliminating these foods, just cut back your portions. Are you getting enough fruits and vegetables? If not, you may be missing out on vital nutrients.
9. Make changes gradually. Just as there are no "superfoods" or easy answers to a healthy diet, don't expect to totally revamp your eating habits overnight. Changing too much, too fast can get in the way of success. Begin to remedy excesses or deficiencies with modest changes that can add up to positive, lifelong eating habits. For instance, if you don't like the taste of skim milk, try low-fat. Eventually you may find you like skim, too.
10. Remember, foods are not good or bad. Select foods based on your total eating patterns, not whether any individual food is "good" or "bad." Don't feel guilty if you love foods such as apple pie, potato chips, candy bars or ice cream. Eat them in moderation, and choose other foods to provide the balance and variety that are vital to good health.