One Month of Band Rules

Apr 09, 2009

A MONTH OF RULES FOR SUCCESS WITH YOUR ADJUSTABLE GASTRIC BAND   INTRODUCTION These rules are based on information provided by my bariatric surgeon and bariatric nutritionist. They are not listed in order of importance.     DAY 1
DON'T DRINK WHILE YOU EAT OR FOR 30-60 MINUTES AFTERWARDS
1.  Drinking while you eat or immediately afterwards will wash the food through your stoma.
2.  The faster the food leaves your stomach, the sooner you're going to be hungry again.
3.  When the food vacates your stomach quickly, it is all too possible to overeat.
4.  When your stoma is full of food (especially dense food like animal protein), liquid can have
      a hard time getting through it.  A PB can result.  Never PB'd?  Take my word for it - not fun,
      and definitely not socially acceptable.

Pre-op, I thought this rule was going to be the hardest to learn to live with, but it only took me a week or so to get used to it.  I don't even put a beverage on the dining table.

If you eat something spicy, or salty, or strongly flavored, and think you will die if you don't take a drink, rinse your mouth with water and spit it out.  Or suck on a Tic Tac. Better yet, go brush your teeth as soon as you've finished eating.  Your dentist will thank you!

I don't know why some surgeons say to wait 30 minutes while others say 60 or even 90 minutes.  My surgeon says 30 minutes is fine.  If I'm at home, I set the kitchen timer for 30 minutes and when it buzzes, I start drinking again. 

Some people say they can't get their 64+ oz of liquids in each day because of the no-drinking while/after eating rule.  That has never been a problem for me.  Except when you're newly post-op or adjusting to a new fill, you should be able to drink generously.  I estimate that I'm awake for 14 hrs a day.  6 hrs of that is devoted to eating my meals and snacks and a 30-min waiting period after each meal or snack (that's allowing 30 min/meal - sometimes I don't take that long).  That leaves 8 hrs for drinking liquids.  If I drink 8 oz per hour, I get my 64 oz in easily.  So I don't want to hear any more excuses about not being able to drink enough! (We'll take about the importance of drinking water in another post)


DAY 2   TAKE TINY BITES The purpose of digestion is to convert large organic molecules that cannot be absorbed into the blood stream or cells into smaller molecules that can be absorbed. Digestion begins in the mouth, where saliva mixes with the food and begins to break it down. By taking tiny bites, you are aiding the breakdown of your food, so it gets digested properly and gets through your stoma without problems.   Try cutting all your solid food into pencil-eraser size pieces before you put it in your mouth. The very act of cutting up your food and chewing it one little piece at a time will slow down your eating and may actually help you enjoy it more. I used to hoover down huge bites of food so quickly and indiscriminately, I hardly tasted it. If I did that now, I’d make myself sick. Not a pretty sight.     DAY 3   AVOID ALCOHOL Aw, what a party pooper! Well, I do enjoy a glass of wine, but…   My surgeon told me: no alcohol for 6 months after surgery because it can irritate the stomach.   Here are some other reasons to avoid alcohol:   1.       empty calories with no nutritional benefit 2.       alcohol lowers your inhibitions, making it all too easy to overeat, make poor food choices, and take yet another drink 3.       increased risk of liver damage, hypertension, some cancers (including breast cancer, stroke, accidents, and more 4.       potential for transfer addiction 5.       after WLS, your small upper stomach pouch may have trouble processing the alcohol, which can make you a cheap drunk, or get you into trouble   I know they say that a glass of red wine is good for your cardiovascular health, but before you take that drink, ask yourself if you’re using the health thing to justify something you would do regardless? Would you rather “spend” 100 calories on a glass of wine that runs right through your stoma, or spend it on solid food that keeps you satisfied for hours?   Here’s my alcohol testimony. Last April, I went on vacation in the Caribbean. I had great restriction at the time, did not overeat, but gained 6 lbs in 5 days. Why? Liberal consumption of alcohol.   If the prohibition of alcohol is enough to make you reconsider WLS, I would suggest that you need to address your drinking issues even more urgently than you need to address your eating issues.     DAY 4   EXERCISE REGULARLY   I know, I know. I hated exercise too. When you’re obese it can be hard to get your body to cooperate, your endurance may not be so great, and you may have medical conditions (like bad hips or knees) that make exercise difficult.   Weight loss is a pretty simple formula: you must burn more calories than you consume. You can lose weight without exercising if you cut your food intake enough, and the band certainly helps with that, but you can maximize your weight loss by exercising more.   Afraid that exercise will make you gain weight as you build muscle mass? Not too likely, especially if you’re a woman (women don’t bulk up the way men do because we don’t have enough testosterone). And I wouldn’t mind weighing 500 lbs if I could wear a size 6.   In addition to burning calories, exercise has the following benefits: lowers blood pressure, lowers cholesterol, regulates blood sugar (by helping the body handle insulin more efficiently), improves heart and lung function, prevents certain cancers, strengthens your bones, prevents strokes, prevents back pain, improves sleep, strengthens and tones your muscles (and more muscle means a faster metabolism), and best of all (for me) it improves your mood.   Exercise doesn’t have to be boring. I do a wide variety of activities to keep my workouts interesting. Walking is wonderful exercise (especially if you listen to music while you walk), and walking outdoors doesn’t cost a thing (except maybe the price of a good pair of walking shoes). I started out with several 5-minute walks a day and gradually built up to 40-60 minutes of exercise a day. If you’re chair-bound because of a disability or medical condition, there are chair aerobics DVD’s available.   So, get moving!     DAY 5   DON’T WATCH TV OR READ WHILE YOU EAT   For me, it’s way too easy to overeat, or to neglect my band eating skills and get into trouble, if I’m distracted while eating (by watching TV, reading, or even socializing). I get more enjoyment out of my food – and a higher satiety level – if I really pay attention while I eat. I can’t tell you how many times (in my pre-op days), I ate myself into a coma and didn’t even remember how the food tasted.     DAY 6   SEE YOUR SURGEON ON A REGULAR BASIS   I see my surgeon once a month (more often if needed) whether I get a fill or not. I’m glad he follows me that closely. The 1-1/2 hour drive (one way) is well worth it to me.    Every time I see him, Dr. A. answers my questions; offers helpful suggestions; and monitors my weight loss, any symptoms I’m having, and my general health.   He listens to my heart and lungs and palpates my abdomen. Every 3-4 months, he orders blood tests to check my cholesterol, triglycerides, blood sugar, A1C, potassium, calcium, iron, B12, folate, and other levels, and reviews the results with me.    Dr. A. says that patients who don’t come for regular follow up visits after surgery are less likely to achieve their weight goals, and more likely to regain weight.   Don’t ever be afraid or embarrassed to ask questions of your surgeon (or whoever he/she designates to take care of you).  Don’t let them rush you through an office visit. It’s their job to answer your questions, address your concerns, (if indicated) refer you to another medical professional, and attend to your needs, however long that takes.     DAY 7   MAKE A PLAN FOR AFTERCARE   For most people, the band doesn’t work without fills. Achieving (and maintaining) optimal restriction can take more than one fill. Since joining OH, I’ve been surprised by how many members get banded by a surgeon located a considerable distance from their home (such as Mexico), with no plan for how to get fills, aftercare, or possible emergency treatment (it’s not safe to assume that your local ER will know what to do if you need an unfill). I realize that some people aren’t as lucky as I am in their geographic location. I would certainly travel a great distance to see a superior surgeon, or if I were self-pay and could only afford a Mexican surgeon. But you need to consider all this, and its effect on your budget (both in terms of time and money), before you go into the operating room.     DAY 8   EAT SLOWLY, BUT NOT FOR MORE THAN 30 MINUTES AT A TIME   Eating too fast is a good way to end up with food stuck in your stoma.   But if you can’t finish your meal in 30 minutes, put it away. It takes about 30 minutes for food to move out of your stomach. If you continue to eat after 30 minutes, you may end up overeating because by then you’ll have room for more food than you had originally planned to eat.   Try putting your eating utensils down between each bite of food. This automatically slows me down. Instead of concentrating on shoveling up that next forkful of food, I’m able to concentrate on chewing and enjoying the food that’s already in my mouth. Some people find that using a baby spoon helps them take smaller bites and thus slows down their eating.     DAY 9   HAVE REALISTIC WEIGHT LOSS EXPECTATIONS   Average weight loss with the band is 1-2 lbs/week. If you expect to have band surgery and wake up the next day 100 lbs lighter, you’re going to be disappointed (OK, I know I’m exaggerating).   The 1-2 lbs/week rate of weight loss average includes patients who lose no weight and patients who lose a lot of weight. It’s certainly possible to lose more than 2 lbs/week with the band (especially in people who start out heavier), but I see too many people berate themselves for being a failure when actually they’re losing very well.   And while it would be nice if we could all lose weight at a nice, steady rate, my own weight loss has been very uneven – a few pounds one week, one pound the next week, nothing the week after that, and so on. I have survived numerous weight loss plateaus that seemed endless – but they did eventually end. Try not to let the scale mess with your head. If you’re letting a daily scale reading ruin your day, I suggest that you lock your scale in the trunk of your car, or have a loved one hide it from you, and weigh yourself once a week.     DAY 10   AVOID CARBONATED BEVERAGES   Carbonated beverages include soda (diet or regular), beer, sparkling water, champagne, tonic, and soda water. And don’t forget effervescent products like Airborne and Alka Seltzer.   The theory is that carbonation can stretch your stomach pouch. I don’t know how likely that is, but why risk it?   Another consideration: the banded gastrointestinal system may not be able to handle carbonation as well as an unbanded system, so drinking carbonated beverages can cause discomfort, including burping (my experience) and intestinal gas. What’s so bad about burping? The act of burping can carry acid into the esophagus, which can cause lesions.   Carbonated beverages can be a gastric irritant. The stomach reacts to this by applying its own supply of “antacid” – the calcium in your blood – and the blood replenishes its supply by drawing calcium out of your bones.  And most sodas contain phosphoric acid, which also leaches calcium from the bones. Which is why some people call soda “osteoporosis in a can”.     DAY 11   DRINK AT LEAST 64 OUNCES OF WATER A DAY   Plus another 8 ounces for every 25 lbs overweight you are. And more when you exercise or spend time outdoors in hot weather.   There is some debate over whether adults really need to consume this much water, but according to information my nutritionist gave me, you need it because: 1)       drinking water can suppress your appetite 2)       a decrease in water intake will cause fat deposits to increase 3)       an increase in water intake can actually reduce fat deposits   Your kidneys can’t function properly without enough water. When they don’t work to capacity, some of their workload is transferred to the liver. One of the liver’s primary functions is to metabolize stored fat into usable energy for the body. But if the liver has to do some of the kidneys’ work, it can’t operate at full throttle, so fat remains stored in the body and weight loss slows or stops.   Inadequate water consumption can also cause: 1)       constipation 2)       dehydration 3)       fluid retention 4)       muscle spasms   I often hear bandsters complain about how difficult it is to drink 64 ounces of water a day when you’re not allowed to drink for a certain time period before and after you eat. As I mentioned in the Day 1 section, that has not been a problem for me.  Except when you're newly post-op or adjusting to a new fill, you should be able to drink generously.  I estimate that I'm awake for 14 hrs a day.  Six hours of that is devoted to eating my meals and snacks and a 30-min waiting period after each meal or snack (that's allowing 30 min/meal - sometimes I don't take that long).  That leaves 8 hours for drinking liquids.  If I drink 8 oz per hour, I get my 64 oz in easily.    If you don’t like water, try flavoring it with one of the billion flavors of Crystal Light or SF Kool-Aid. Or add a squeeze of lemon, lime, or orange (Real Lemon now sells packets of crystallized lemon, lime and orange – found near sugar and sweeteners in the supermarket). Or drink herbal tea. My nutritionist also counts other liquids (like skim milk, protein shakes, broth, juice, decaf coffee or decaf tea) as part of the 64 ounce daily minimum. Caffeinated beverages do not count because they can act as a diuretic.     DAY 12   AVOID LIQUID CALORIES   Calories in liquid form vary nutritionally (skim milk, low-sugar fruit juice, some fruit smoothies, tomato juice, V-8 juice, juiced veggies, and protein shakes are fine, while milkshakes, alcohol, regular fruit juice, some fruit smoothies, and fancy coffee/tea drinks are not so fine), but for most bandsters, they’re all the same in one respect: they don’t stay in your stomach long enough to keep hunger at bay.   Two of the purposes of the band are to (1) create a small upper stomach pouch and thereby limit how much food you can eat at one time, and (2) create a small stoma (the opening between the upper and lower stomach) which slows down the movement of food so that your smaller meals keep you satisfied longer. Drinking liquid calories circumvents both of these features because liquids run right through the stoma, so you get calories without satiety.   There are times when drinking liquid calories may be necessary – during a pre- or post-op liquid diet, or for a day or so after a fill (depending on your surgeon’s instructions), or when recovering from a stuck episode or anything else that irritated your stoma, or when treating a band slip.   What about protein shakes?  They do have a useful role in the life of a bandster. If your band is too tight in the morning to allow you to eat solid food, my nutritionist says it’s better to drink a protein shake than to skip breakfast altogether (for more on this, see Day 14). Some bandsters (especially those who have never been breakfast eaters) find that a protein shake in the morning is an easy option. Others may find it necessary to supplement with protein shakes if they’re struggling to get in enough protein each day.   Here’s a personal story to illustrate how this rule works. My band has been very tight recently, so I have been drinking a protein shake made with skim milk and banana for breakfast. It’s packed with protein and “costs” me 315 calories. But I would much rather eat my favorite breakfast of Weight Control oatmeal made with skim milk and banana, which “costs” me 284 calories, because the oatmeal (which isn’t even a very solid food) keeps me full for 2-3 hours, whereas the protein shake keeps me full for maybe 30-45 minutes.     DAY 13   AVOID SLIDER FOODS   This rule is closely related to the Day 12 rule (Avoid Liquid Calories).   Slider foods are foods that can slide through your stoma all too quickly and easily.  They may be nutritious, but often they're junk, and the bottom line is, they don't keep you feeling full for very long.  I still eat the nutritious ones, usually when my band is too tight for me to eat anything else (in the morning), but I have to keep a careful eye on this whole thing...

Here are my slider foods:

Nutritious:
yogurt
SF pudding
skim milk
cottage cheese
ricotta cheese
mashed potatoes
soft-boiled eggs Scrambled eggs
protein shakes
smoothies Refried beans Guacamole
anything pureed
applesauce
juice
soup

Not So Nutritious:
potato chips tortilla chips alcohol candy
cookies
ice cream
milk shakes
cream cheese
thin crackers

Undecided category:
nuts (high in protein, often high in good fats, but overall high in calories, and I find portion control
   is a real challenge)
raisins and other dried fruit (good for you, but high in calories, and again, portion control is a challenge)
pretzels (sometimes they get stuck in my stoma)
thick crackers (can get stuck)
popcorn (the hulls can accumulate in your stoma)
soft cheese (like Boursin, Laughing Cow)   Also related to this is what’s known as Soft Calorie Syndrome, which can happen when you’re band is chronically so tight that all you can eat are soft (and liquid) calories that tend to be higher in calories, carbs and fats than solid foods. And as a result, your weight loss stalls (or you gain weight). This has happened to me more than once during my WLS journey.     DAY 14   EAT BREAKFAST   Your mother was right: breakfast is the most important meal of the day. Studies have shown that eating breakfast gives you a better attention span, greater focus, and more productivity. It can lower your cholesterol, thereby reducing your risk of heart disease, because people who eat breakfast usually consume less dietary cholesterol than those who don’t eat breakfast. Eating breakfast makes it easier to achieve your daily nutritional goals, and it minimizes impulsive snacking as well as overeating at other meals.  People who eat breakfast tend to consume fewer calories throughout the day than people who don’t eat breakfast.   When you skip breakfast, you are in effect subjecting yourself to a 15-20 hour fast during which your body is unable to produce the enzymes needed to metabolize fat. Your metabolic rate drops. Your blood sugar drops, which makes you hungrier and reduces your energy level. People who skip breakfast have a metabolic rate 4-5% below normal, which translates to a weight gain of 8 lbs per year.    My nutritionist recommends eating within one hour of waking each day. When you wake up in the morning, your blood sugar and glycogen stores (carbohydrates stored in your muscles and liver) are depleted and your body is searching for fuel. If you don't feed your body it goes into conservation mode, drops your metabolism, preserves your fat stores and eventually uses muscle tissue for the energy it needs.   In one weight loss study, two groups of women were compared. The first group followed a low calorie diet (1200 calories) that included a balanced protein/carbohydrate intake. This group ate 50% of their daily calories in the morning (600 calories). The second group followed a low calorie (1000 calories), low carbohydrate diet and ate 25% of their calories in the morning. The first group lost an average of 40 pounds over 6 months, while the second group lost 10 pounds (28 pounds in the first 4 months, followed by an 18 pound regain).   If you don’t like traditional breakfast foods, eat something you do like for breakfast. My husband eats leftovers from the previous night’s dinner for breakfast. If you’re too rushed to prepare breakfast, grab something quick: yogurt, cottage cheese, a hard-boiled egg, a slice or two of deli meat or cheese, a piece of fruit, a protein bar or granola bar. If your band is too tight to allow solid food in the morning, have a protein shake. Try to include both a protein (for long-lasting energy) and a carb (for quick energy) in your breakfast.     DAY 15   GET AT LEAST 8 HOURS OF SLEEP EACH NIGHT How much you sleep affects the production of two hormones, grehlin and leptin, that are instrumental in managing your weight. Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, which is produced in fat cells, sends a signal to the brain when you are full. Inadequate sleep drives leptin levels down, so you don't feel as satisfied after you eat, and causes ghrelin levels to rise, so your appetite is stimulated and you want more food. In a joint project, researchers at Stanford University and the University of Wisconsin studied 1,000 volunteers who reported the number of hours they slept each night.  Doctors measured the participants’ ghrelin and leptin levels and charted their weight. The result:  those who slept less than eight hours a night not only had lower levels of leptin and higher levels of ghrelin, but they also had a higher level of body fat.  Those who slept the fewest hours per night weighed the most.   DAY 16 KEEP A FOOD & EXERCISE LOG A recent study by the Kaiser Permanente Health Research Center in Oregon showed that people who log their food and exercise lose twice as much weight as people who don’t keep a food. Here are some ways food and exercise logs can help you achieve your weight loss goals:

• Knowing a food will go into your log prompts you to make you make a careful choice about whether to it eat it not.
• Knowing a food or exercise will go into your log keeps you honest about what you’re really putting in your mouth or how much you’re really moving.
• Logs can draw attention to unhelpful eating patterns or things you might have been doing without realizing it (for example, eating in the car, or missing meals and then eating whatever you can get your hands on).
• Logs can help you be more aware of situations, feelings or thoughts that make you eat more than you had planned to.
• Exercise logs help you plan to be more active on a daily basis.
• Food logs can help you meet your daily nutritional goals by tracking your protein, carb, fat, and other intake.
• Logs give you something to look back on to see how things have changed over time, and can help explain unexpected weight gain.
• Logs give you a tangible record of your accomplishments and can help facilitate your meetings with your nutritionist or surgeon.

Online services make keeping logs easy. Most services have extensive databases of foods and activities, with a feature that allows you to add custom foods or meals. You just look up the food using a search function, specify the quantity, and add it to the log. Many of these services will calculate what your daily caloric intake should be based on your height, weight, activity level, and weight loss goals. I like the software that I bought at www.dietorganizer.com because it’s user-friendly and has lots of neat reports, but there are many free sites, including: www.myfooddairy.com
www.sparkpeople.com
www.my-calorie-counter.

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