07 January 2021


Section 5a: BEFORE SURGERY – GASTRIC BAND PRE-OPERATIVE DIET & LIVER SHRINKAGE


Why do I need to follow a pre-op diet before gastric band surgery?

The pre-op diet is required to shrink your liver, which allows your surgeon to operate more easily and safely. The diet achieves this by containing a maximum of 100g of carbohydrate and 1000kcal (calories) per day, which forces the stores of glycogen (carbohydrate) in your liver to reduce.

 

You may also need to lose a certain amount of weight before your gastric band operation, either by the request of your surgeon/consulting practitioner, or to qualify for admission to a certain hospital. The diet will also assist with achieving this.

 

If you fail to follow this diet, you run the risk of having your procedure cancelled or abandoned, and the cost of the procedure cannot be refunded. Please do not be tempted to have a special meal or larger meal before surgery, as this will reverse the liver-reducing effects of the diet.

 

Do I need to speak to a dietitian before gastric band surgery?

Yes. Your Patient Advisor will arrange a preoperative consultation (face-to-face or by telephone) with the dietitian to discuss the pre-operative diet and the short- and long-term post-operative dietary guidelines which are crucial for success. You will receive an email confirming the date and time, and it is imperative that you keep this appointment; if you are unsure of when your appointment is, please contact your Patient Advisor.

 a preoperative consultation (face-to-face or by telephone) with the dietitian

How long do I need to follow a pre-operative diet for?

This depends on your BMI – learn more about calculating your BMI here.

 

BMI (kg/m2)

Length of pre-operative diet

50 or above

2-4 weeks

40-49.9

At least 2 weeks

35-39.9

At least 1 week

30-34.9

 

Generally, no specific preoperative diet is required, although we would

strongly recommend that you follow a healthy low fat eating plan before

surgery and follow this plan for 2-3 days prior to surgery.

 

Please note this is merely a guide, and your surgeon or consulting practitioner may advise differently. You should always follow their advice.

 

What if I have diabetes?

If you have diabetes and are treated with insulin, liraglutide (Victoza), exenatide or a sulphonylurea tablet (glicazide, glibenclamide, tolbutamide, glimepiride, glipizide), you may need to adjust the dose of your insulin or medication. Please contact your Diabetes Specialist Nurse / Practice Nurse / GP before starting the pre-operative diet.

Do I need to take any supplements during the gastric band pre-operative diet?

It is recommended you take a multivitamin and mineral supplement for the duration of the pre-operative diet, as it will vastly reduce your intake of these. Any brand is suitable, providing it is complete – it must contain vitamins and minerals. Good quality off-the-shelf varieties include:

 

A variety called Forceval is available on prescription or over-the-counter. It is also available in a soluble form, so can be used in the initial period after surgery when solid tablets are not to be taken.

 

Does the gastric band pre-operative diet have any side-effects?

You may become dehydrated and constipated as a result of the reduced carbohydrate in the pre-op diet, and so you will need to drink at least 2 litres of additional fluid per day.

 

Suitable fluids include water, ‘no added sugar’, ‘sugar free’ or ‘diet’ flavoured water/squash/cordial/fizzy drinks, tea (including fruit/herbal varieties) and coffee. Any milk should be taken from the allowance given in the plan you choose. No sugar is allowed, but you can use any type of artificial sweetener. Caffeinated drinks can also be included. If you wish to have a savoury drink, you may have an Oxo or Bovril.

 

This dramatic change in dietary habits can also cause other unpleasant side-effects including lower energy levels, headaches, mental dullness, temporary dizziness, nausea, diarrhoea, sluggish mobility and bad breath (you can have sugar-free chewing gum to help with this).

 

What are the options for the pre-operative diet?

There are 3 options:

  1. Option 1 is based on liquids (milk or meal replacement drinks) and yogurts
  2. Option 2 is based on solid food, with a vegetarian option available
  3. Option 3 is a mixture of the two above

 

 

Option 1:  liquids (milk or meal replacement drinks) and yogurts

Table 1

Milk

Amount (ml)

All cow’s milk (including lactose-free) but NOT whole milk

1800

Soya milk (sweetened) or soya light milk

2000

Meal replacement drinks

Number of portions per day

Asda Great Shape

4

Celebrity Slim – shakes made from powder, smoothies or soups (vegan options available)

3

Lighterlife fast shakes

4

Slim Fast Advanced Vitality – shakes made from powder

3

Slim Fast Advanced Vitality – ready made shakes /  vegan shakes made from powder

4

Slim Fast – ready made shakes

4

Tesco Slim

4

Please make up the meal replacements as instructed by the manufacturer.

 

Table 2

200ml All cow’s milk (including lactose free) but NOT whole milk

250ml Soya milk (sweetened) or soya light milk

125g Activia 0% Blueberry / Cherry / Peach / Plain / Raspberry / Strawberry / Vanilla

115g Danone Light and Free Greek Style Yogurt Blueberry / Cherry / Coconut / Lemon / Passion Fruit Peach / Raspberry / Strawberry

120g Muller Light Greek Style Cherry / Coconut & Vanilla / Lemon / Mango / Raspberry / Strawberry

90g Weight Watchers Fromage Frais Apricot / Blackberry / Cherry / Forest Fruits / Peach / Raspberry / Strawberry

200g Alpro plain

If you find a yogurt that is not listed, it must provide a minimum of 5g protein and no more than 110kcal and 10g carbohydrate per portion.

Please note regarding meal replacement products: If you want to use a meal replacement product that is not listed, please speak with your dietitian before doing so as many are not suitable for the pre-operative diet.

 

Option 2: Solid food

 

This plan consists of food which you can incorporate into your day as you wish. If you do not eat meat or fish, there is a vegetarian option available – please ask your dietitian in your preoperative appointment for a copy of this.

 

All food must be weighed using digital kitchen scales. IMPORTANT: The weighing of food is crucial to ensure accuracy. Do not estimate anything. If you feel you will not be able to do this, we would strongly recommend that you follow Option 1 or 3 instead as they require less weighing and measuring. Please note that the weights given are the maximum allowed, but you do not have to have the full amount.

 

Number of Portions Allowed

 

The table below shows how many portions of each food group you are allowed per day.

 

Food group

Number of portions

Carbohydrate

3

Protein

2

Vegetables/salad/beans/pulses

4

Fruit

2

Milk/yogurt

2

 

 

 

 

 

 

 

 

 

 

If there are any foods not listed that you would like to include, please mention this to the dietitian. If nutritional information for the food/product is available, they can work out the portion size in grams.

 

Carbohydrate – 3 per day

 

Food

1 portion (g)

Food

1 portion (g)

Bread/pitta bread

20

Pasta, boiled

40

Couscous, plain, cooked

40

Pasta / rice, uncooked

10

Couscous, plain, uncooked

10

Plain non sugary cereal

10

Crumpets

20

Rice, boiled

30

Egg noodles, boiled

70

Rye crispbread

10

New potatoes, boiled

60

Sweet potato, boiled

40

Old potatoes, boiled/baked, without skin

50

Wrap

20

 

NOTE: 1 carbohydrate portion equates to 2 vegetable/salad/beans/pulses portions, if you wish to swap to these instead. If you are choosing gluten free alternatives, the portion size is the same as the gluten-containing food listed above. Weights of wholemeal/brown options are the same.

 

Protein – 2 per day

 

Food

1 portion (g)

Food

1 portion (g)

Beef mince, extra lean, 5% fat, stewed

110

Pork, fillet, fried (spray oil)

100

Cheddar cheese, half-fat

70

Prawns, boiled

180

Chicken roasted/grilled, without skin

90

Salmon, pink, canned in brine, drained

120

Cod, poached, drained

200

Tuna, canned in brine/mineral water, drained

180

Ham, honey roast/breaded

160

Turkey mince, stewed

130

 

Vegetables/salad/beans/pulses – 4 per day

 

Food

1 portion (g)

Food

1 portion (g)

Baked beans, regular

30

Lettuce

210

Beetroot, pickled

80

Mushrooms, raw

230

Broccoli, boiled

70

Onions, raw

60

Broccoli/cauliflower, raw

80

Pea (frozen), boiled

40

Carrots/cauliflower, boiled

100

Quinoa, uncooked

20

Celery, raw

500

Red kidney beans, canned

20

Cucumber

300

Spinach, boiled/raw

120

Green beans, boiled

100

Sweetcorn, kernels, canned, drained

20

Leeks, boiled

140

Tomatoes, raw

150

Lentils, boiled

20

Turnip, boiled

250

 

Fruit – 2 per day

 

Fruit

1 portion (g)

Fruit

1 portion (g)

Apples, raw

80

Oranges

110

Bananas

40

Pears, raw

100

Blueberries

120

Pineapple

90

Grapefruit

140

Raisins

10

Grapes

60

Strawberries

160

Melon, galia/honeydew

150

Watermelon

140

All weights of the fruits are of the edible components, i.e. no peel or inedible skin.

Milk/yogurt – 2 per day

 

200ml All cow’s milk (including lactose free) but NOT whole milk

250ml Soya milk (sweetened) or soya light milk

125g Activia 0% Blueberry / Cherry / Peach / Plain / Raspberry / Strawberry / Vanilla

115g Danone Light and Free Greek Style Yogurt Blueberry / Cherry / Coconut / Lemon / Passion Fruit Peach / Raspberry / Strawberry

120g Muller Light Greek Style Cherry / Coconut & Vanilla / Lemon / Mango / Raspberry / Strawberry

90g Weight Watchers Fromage Frais Apricot / Blackberry / Cherry / Forest Fruits / Peach / Raspberry / Strawberry

200g Alpro plain

 

Drinks: At least 2 litres of fluid per day, as described earlier on in this section. If you are having tea or coffee, you will need to use milk from the allowance above.

 

Alternatives: The dietitian will be able to provide you with a comprehensive list of alternatives if you do not like some of the listed foods. If you wish to have the vegetarian option, please ask your dietitian.

 

Seasonings/flavourings/additions: You may use any fresh or dried herbs or spices (including chilli) to flavour your meals.

 

Do not use any oil, butter, spread/margarine, cream or ready-made sauces (including salad dressings, mayonnaise & salad cream).

 

You can of course make your own sauces using allowances above. You may also use up to 100ml daily of any type of vinegar. You may use up to 5 sprays of 1kcal per spray oil per meal if required.

 

Sample plan

 

We have created a sample plan for three days to show how you might put your allowances together.

 

 

Day 1

Day 2

Day 3

Breakfast

20g crumpets

160g strawberries

1 yoghurt from list

10g plain unsweetened cereal with milk from allowance

150g fresh melon

20g bread

140g watermelon

1 yogurt from list

Lunch

Rice salad:

30g boiled rice

180g tuna (in water)

20g sweetcorn

150g chopped tomatoes

Herbs and a splash of balsamic vinegar to flavour

20g pitta bread

160g honey roast ham

Salad made from:

150g cherry tomatoes

210g lettuce

300g cucumber

(Serve half at lunch and half with dinner)

 

10g rye crispbread with

70g grated half fat cheddar

60g chopped onion and

80g pickled beetroot

Dinner

Roast dinner:

40g boiled sweet potato

90g roast chicken (no skin), spices to flavour

100g boiled green beans and 100g boiled cauliflower

50g baked potato (no skin) with 70g grated half-fat Cheddar and 30g Baked Beans.

 

Serve with remaining salad from lunch

 

Chinese Prawn Fakeaway:

70g boiled egg noodles  mixed with 180g boiled prawns

100g of carrot batons and

80g broccoli florets stir-fried in up to 5 sprays of frylight. Add chilli and ginger to taste.

Snacks

60g grapes

1 fresh pear

1 pot of yogurt from list

120g blueberries

Additional milk

200ml semi or skimmed milk for drinks

200ml semi or skimmed milk for drinks

200ml semi or skimmed milk for drinks

Drinks

Drinks: drink at least 2 litres of fluid as described in your Patient Information Booklet

Drinks: drink at least 2 litres of fluid as described in your Patient Information Booklet

Drinks: drink at least 2 litres of fluid as described in your Patient Information Booklet

 

 

 

 

Option 3: Milk or meal replacement drinks with solid food

 

This plan consists of meal replacement shakes or milk and some food which you can incorporate into your day as you wish.  If you do not eat meat or fish, a vegetarian option is available – please ask your dietitian in your preoperative appointment for a copy of this.

 

This plan involves less weighing and measuring than Option 2, yet still allows some solid food unlike

Option 1.  As such, you may find it easier and more practical to follow.

 

  1. Milk or meal replacement drinks

 

Firstly, decide what milk or meal replacements you are going to have each day.

Table 3

Milk

Amount (ml)

All cow’s milk (including lactose free) but NOT whole milk

1100

Soya milk (sweetened) or soya light milk

1300

Meal replacement drinks

Number of portions per day

Asda Great Shape

2

Celebrity Slim – shakes made from powder, smoothies or soups (vegan options available)

2

Lighterlife fast shakes

2

Slim Fast Advanced Vitality – shakes made from powder

2

Slim Fast Advanced Vitality – ready made shakes /  vegan shakes made from powder

2

Slim Fast – ready made shakes

2

Tesco Slim

2

 

Please make up the meal replacements as instructed by the manufacturer.

 

  1. Solid food

 

Then choose what food you are going to have each day. The table below shows how many portions of each food group you are allowed per day.

 

Food group

Number of portions

Carbohydrate

1

Protein

1

Vegetables/salad/beans/pulses

2

Fruit

1

Milk / yogurt

1

 

 

 

 

 

 

 

 

 

 

Please refer to option 2 earlier in this section for the suitable foods in each group.

 

If you prefer to follow the vegetarian option, there are two ways you can do this. You can exclude the milk/yogurt portion and have the following portions of each food group per day:

 

Food group

Number of portions

Carbohydrate

1

Protein

2

Vegetables/salad/beans/pulses

2

Fruit

1

 

 

 

 

 

 

 

 

 

Or you can exclude the carbohydrate and fruit portions and have the following portions of each food group per day:

 

Food group

Number of portions

Protein

2

Vegetables/salad/beans/pulses

2

Milk / yogurt

1

 

 

 

 

 

 

 

Please ask your dietitian for the list of vegetarian foods.

 

If there are any foods not listed that you would like to include, please mention this to the dietitian. If nutritional information for the food/product is available, they can work out the portion size in grams.

 

Drinks: At least 2 litres of fluid, as described earlier on in this section. If you are having tea or coffee, you will need to use milk from the allowance above.

 

Alternatives: The dietitian will be able to provide you with a comprehensive list of alternatives if you do not like some of the listed foods. If you wish to have the vegetarian option, please ask your dietitian.

 

Seasonings/flavourings/additions: You may use any fresh or dried herbs or spices (including chilli) to flavour your meals.

 

Do not use any oil, butter, spread/margarine, cream or ready-made sauces (including salad dressings, mayonnaise & salad cream). You can of course make your own sauces using allowances above. You may also use up to 100ml daily of any type of vinegar. You may use up to 5 sprays of 1kcal per spray oil per meal if required.

 

All the information above is correct at time of production.

 

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