Dr. Paul O’Brien is a world leader in the Lap-Band procedure and was involved in its design and testing in the 1990’s. He is also the author of the book ‘The Lap Band Solution’ and the creator of The 8 Golden Rules . I have met him at our clinic and he is engaging, brilliant and we routinely give out his book ‘The Lap Band Solution’ to our patients when they have booked their surgery. It is full of easy to understand, and mostly useful information on living with the band.
If you haven’t already watched ‘The 8 Golden Rules’ I highly recommend you do. It is about 30 minutes of some of the best information you will receive on how your band works. Having said that, when we encourage our patients to watch the videos we always explain that there are parts that we don’t entirely agree with. From listening to my patients and reading various posts on You Tube there does seem to be some confusion around them and I’d like to “De-Mystify” the rules.
- Rule number 1: Eat Small Portions. Yes absolutely portion control is one of the primary ‘rules’ of living with the band. Many patients will routinely say “if I could eat smaller portions I wouldn’t have got the band”. I understand this, however it is a vital part of success with the band. The band is not placed to stop a person from eating. It is there to control hunger when a person decides to eat less food. In normal ‘diets’ eating less food to lose weight always leads to hunger which inevitably leads to failure in the diet. When your band is properly adjusted a small meal keeps your hunger away for around 4 hours. Dr. O’Brien recommends that individuals use a small plate and small utensils to consume 1/2 cup of food. Small plate, small fork yes, excellent ideas….1/2 a cup of food? You’ve got to be kidding. We tell our patients to eat around a cup of food, cut it up small and eat it slowly. Your meals should always include a healthy choice of solid protein, vegetables and limited starchy carbohydrate. We also do not encourage people to skip breakfast. For some the band is tighter in the morning due to the fluid distribution in your body and hence you may not be hungry when you first wake up. As the day goes on and gravity draws some of our tissue fluids down the band ‘loosens’ a bit. I’m not recommending that you force-feed yourself in the morning, but as your band loosens do try to have some form of protein. Over the years research has proven that skipping breakfast can hinder weightloss http://www.webmd.com/diet/features/lose-weight-eat-breakfast. Start your day with protein and limit the carbohydrates (one of the worst choices I would say is breakfast cereal with milk…all carbs and goes across the band quickly so no satiety).
- Rule Number 2: No Snacking. The band is all about not being hungry. If you find you are hungry in less than four hours after a meal you have to ask yourself why. Did you have adequate protein? Was your food of solid consistency? Did you eat your food slowly? If you answer “yes” to all of these questions than your band may need an adjustment. When you are trying to lose weight you have to look at the quality of food you are consuming and your calorie intake vs output. Your caloric intake must obviously be less than your caloric output to lose weight. To lose a pound of fat a week they say you must consume approximately 500 calories less a day or expend that many calories. Really to fully understand how many calories less you need to consume you have to take into account your RMR (resting metabolic rate), but this will be a topic for another blog. Suffice it to say your intake must be less than your output. If you can incorporate a healthy snack in there to control hunger or cravings then go for it. If you have your lunch at 12:00 or 1 pm and plan to go until dinner with nothing to eat in between this may lead to a variety of things: first bite syndrome (you get so hungry that you take too big of a first bite and end up ‘pbing’ or sliming), snacking on the ‘wrong’ things, or consuming too much at dinner and possibly into the evening. It is far better to be prepared and to have a healthy protein snack on hand that you can have say around 4 pm if you know dinner won’t be until 6 pm. I will include some examples of low-calorie, high protein snacks in the nutrition section.
- Rule Number 3: Eat Slowly. I agree with most of what Dr. O’Brien discusses in this section. One thing he mentions however is to “stop eating when you are no longer hungry”. This I find is a dangerous attitude to have. How many of us can relate to the horrible post-turkey dinner feeling associated with Christmas and Thanksgiving? You have your meal, feel good, then go back for ‘just a liiiiiitle bit more’…only to find yourself 20 minutes later feeling bloated, tired and uncomfortable? That is because it takes the brain a good 20 minutes to tell us that we have had enough. With a band (or without) you have to limit your portions and stop eating BEFORE you feel ‘full’ and recognize that your brain may take a while to tell you that you are no longer hungry. Many of us don’t truly understand the feeling of hunger so it is important to stop eating after that small portion of food. Walk away from the table, get yourself busy, and see how long until real hunger returns. Dr. O’Briens description of the squeezing motion that moves the food down the esophagus and across the band is excellent. It is so important to understand this. It is partly the movement of the small bolus of well chewed food across the band that triggers the receptors in the stomach that in turn trigger satiety in the brain. It is imperative to allow around 30-45 seconds AT MINIMUM to pass before your next bite both to trigger this reaction and to avoid dilating the area about the band and risking damaging the stomach receptors that contribute to achieving the feeling of satiety. So I encourage you to use the small fork and put the fork down between bites (yes you will likely always be the last one to finish your meal unless you are enjoying the company of fellow bandsters!). Stop eating before you feel ‘full’..consider ‘full’ a four letter word. It is a case of semantics but what you are looking for with the band is ‘absence of hunger’ or ‘satiety’ and not ‘full’.
- Rule Number 4: Focus on Nutritious Foods As mentioned above, we allow our patients to consume more than 1/2 cup of food and I do not feel you can stay adequately nourished on three 1/2 cup meals a day…neither physically or mentally. Protein is key and you need to consume protein at every meal. The recommended range of protein varies with the recommendation ranging from 0.8-1.5 gm/lb of body weight/day. An easier way is to make sure that your meal is approximately 1/3 protein. Typically I find moist chicken (usually the dark meat or well marinated white meat) and fish are tolerated the best. Red meat such as beef must be top quality (i.e. beef tenderloin) and cooked ‘just right’ as in fairly rare. Other options are legumes, tofu, eggs and dairy such as low-fat cheese and low-fat Greek yogurt (just remember yogurt will pass quite quickly across the band). Again incorporate healthy vegetables into your meals and although it is not necessary to eliminate the starchy carbs just limit them. For our patients we routinely will tell them to have protein that is around the size of a deck of cards, veggies around the size of a computer mouse and then a few tablespoons of a healthy carb such as sweet potato if desired. Like Dr. O’Brien I do encourage my patients to take an adult chewable multivitamin daily.
- Rule Number 5: No Liquid Calories I agree and encourage you to limit all liquid calories. Wouldn’t you rather eat your calories than drink them anyway? Far better to enjoy a crispy apple (maybe without the skin if it tends to stick) and the satiety that will come from eating it slowly than to guzzle a glass of juice and achieve few benefits other than 125 calories. The same goes for liquidy soups, yogurt drinks, cereal with milk, chocolate (yes a liquid unfortunately), high calorie smoothies, frappes and even the large ‘double-double’. We had a patient who was trying hard, eating properly, exercising routinely and yet not dropping a pound. After discussing his diet we then asked about liquid calories. He hadn’t considered the calories he consumed in his daily 6 large Timmy’s double doubles…there are 230 calories in ONE large double double (http://wiki.answers.com/Q/How_many_calories_in_a_large_double_double_coffee), so that was a whopping 1380 calories per day he was consuming in coffee alone…nearly his daily recommended caloric intake! Once he switched to milk in his coffee the pounds started to drop away.
- Rule Number 6: Exercise at Least 30 Minutes Daily It really comes down to ‘eat less and move more’. Exercise benefits all parts of your body: physical, mental and emotional. The number one excuse is that we don’t have time. Everyone’s lives ARE crazy busy and it IS hard to find time to get ourselves moving but we have to start looking at exercise as a necessary part of our day not an option. Just as you would never forgo brushing your teeth because you were too busy, you have to not allow yourself to forgo exercise. It doesn’t have to be 30 minutes all at once. If you can take three 10 minute activity breaks throughout the day that works too! And the more the better as Dr. O’Brien mentions. 30 minutes is good but 60 minutes is GREAT!! Once you make exercise a part of your life it really does become enjoyable and something that your body (and mind) misses if you don’t do it. Choose something you like to do. If you hate to run don’t decide you are going to train for a 5K because you will hate every minute of it and give it up. Walking is the easiest way to start and can be done anywhere. (check out Leslie Sansones “Walk at Home”http://www.walkathome.com/about/leslie-sansone/). Climbing the stairwell for 10 minutes at work will get your heart rate going and burn those calories. Plug in your iPod after work, (lock your bedroom door) and groove to your favorite tunes! The right personal trainer can be highly educating and motivating. Having a work-out buddy can make the work out more enjoyable and you will be less likely to ‘skip it’ if someone is counting on you. Start small and work your way up, just keep moving.
- Rule Number 7: Be Active Throughout the Day In addition to your 30+ minutes of daily exercise try to be mindful of being more active throughout the day. Try wearing a pedometer and setting a goal to increase your steps daily. Park further away wherever you go. Take the stairs. Do some squats while you brush your teeth. Get out in the garden and get dirty, go hit some golf balls at the driving range. Go ‘up’ the ‘down’ escalator…Kidding…just wanted see if you were paying attention.
- Rule Number 8: Stay in Touch Hopefully you are part of a clinic that encourages frequent contact with them. Contact with your clinic is so important for so many reasons. They should be there for you to monitor your progress, examine any band-related issues you may be having, and to offer encouragement and support. If you are having issues that you feel are related to your band (i.e. heartburn, reflux, difficulty with solid foods) your clinic needs to know. Research shows that those who have more frequent contact/follow-up with their clinic tend to have greater success. I have always said that the six most dreaded words that I can hear from a patient are “I was too embarrassed to call”. This means to me that we aren’t doing our job. No one should EVER feel too embarrassed to contact their clinic. We KNOW that this can be a tough road at times, and I know that at our clinic we are always there to listen.
Yours in Health and Fitness,