Attention fellow lap-banders...

Thanks to my dear friend, Jen, WE would like to share the following information related to us banders (though Jen is NOT a bander).  I found this information very informative...somewhat different from what I've been told, but hey, at this point I'm willing to try anything.  So here goes:

by Paul O'Brien, MD, FRACS

The following is a special excerpt from The LAP-BAND Solution - A Partnership for Weight Loss.

We have formulated eight “Golden Rules” for getting the best result from the procedure. It is of vital importance that you follow these rules. The success of the procedure requires us to place the band correctly, but it equally requires that you follow these rules.

I have been tempted to call them guidelines rather than rules. They are not absolute. A thunderbolt will not come from the heavens and strike you down if you break one of them. And, almost certainly, every patient has at one time or another broken each of the rules.

However, they are more than guidelines. They do need to be followed to get the best results. If you do transgress one of them, I want you to feel guilty, admit to your sins and work out how you will avoid doing something so terrible ever again.

But do remember that if the band is not correctly adjusted you will not be able to follow the rules. You must be in the green zone to follow them. So, before being consumed by self loathing at your weakness, do consider if correcting the adjustment is needed and come in to talk to us about it.

We have already discussed these rules within the preceding chapters. Within these rules is a condensation of the advice in those chapters. We are repeating the key elements of the advice. We state the rules, briefly expand on what each rule intends and then restate them. If you are unsure about what they mean, reread the earlier chapters on eating, exercise and adjustment, and if still unclear, talk to us.

THE EIGHT GOLDEN RULES

1. Eat three or less small meals per day
2. Do not eat anything between meals
3. Eat slowly and stop when no longer hungry
4. Focus on nutritious foods
5. Avoid calorie-containing liquids
6. Exercise for at least 30 minutes every day
7. Be active throughout the day
8. Always keep in contact with us

1. Eat three or less small meals per day The Lap-Band works primarily by taking away your appetite. If it is adjusted correctly you should not feel hungry. You may eat up to three times a day. We don’t mind if you eat less than three times per day. Many people do not feel like breakfast and some will miss a midday meal. If you don’t feel inclined to eat, don’t eat. If you find you are getting hungry between meals, tell us. We will probably consider adjusting the band a little tighter.

There is not much room for food as there is a virtual stomach rather than a real space above the band. As you eat, the food seeks a space and you need to keep that space quite small. Therefore each meal should be about the amount of food you can get into half a glass. If you eat more than that you will not lose weight so easily and you will gradually stretch the stomach. This can lead to the need for a further surgery later on to reduce the enlarged stomach.

The adjustability of the band is the key to allowing you to be happy with this small amount of food. If you find that you are tending to eat more than that, tell us and we will consider adding more fluid to the band. Always use a small plate, put a small amount of food on the plate and always try to leave some. Remember the angels. They need their share.

2. Do not eat anything between meals No snacks, no biscuits with your coffee, no fruit, nothing. All food must be restricted to meal times. One of the most frequent causes for failure is the taking of snacks between meals. If you are getting hungry between meals and are tempted to have a snack you must tell us. It is probably due to inadequate adjustment and you may need more fluid added to the band. Between meals you can only have zero calorie liquids – water, mineral water, tea, coffee, low calorie sodas.

3. Eat slowly and stop when no longer hungry When you have eaten enough you will no longer be hungry and signals from your stomach to your brain tell you that you do not need any more. These signals take time to be generated. Give them that time. Each meal should be stretched out over 15 – 20 minutes. If you eat rapidly you will already have eaten too much before you realize that you have had enough. However, do not eat beyond 30 minutes. Throw away whatever you haven’t eaten at that time. That is the end of that meal and you must have nothing else until the next meal.

Try to make each meal last for 15 - 20 minutes. Try to sense when you have had enough and stop before you feel at all uncomfortable. Use a small plate, put a small amount of food on the plate, and develop the habit of always leaving some of it uneaten.

Once the meal is finished it is essential that you take no further food until the next meal time. This has to be avoided absolutely. The slow emptying of the stomach gives you a feeling of fullness which should make it easy for you to achieve this. You must ensure that this indeed does happen.

4. Focus on nutritious foods Foods that are high in protein (meats, especially fish, eggs, dairy, lentils beans and nuts) and foods that are high in complex carbohydrates (vegetables, some cereals) are best. Simple sugars are worst. Be careful with foods that are high in fats as they are dense form of calories. Be careful with fruits as they contain quite a lot of sugar. The good foods can come from all the main food groups and include vegetables, meats, eggs, cereals and dairy. There is no need to focus unduly on the particular foods in fine detail. It is not rocket science. It is simply selecting foods that are good (protein and complex carbohydrates), being careful with those that are not so good (fats, alcohol) and avoiding those that are bad (simple sugars). And take a well balanced vitamin and mineral replacement each day.

5. Avoid calorie-containing liquids Any calorie containing liquids will tend to flow past the restriction of the band and not give you any feeling of satiety. You are then more likely to take too much. You are only allowed to drink:

• water
• mineral water
• tea or coffee (with low fat milk if you wish but no sugar)
• low calorie soft drinks (but be careful with the gas)

An exception to the “no liquid calorie” rule is a glass of wine with meals which we have shown is good for your health and good for your weight loss when taken in a modest amount.

6. Exercise for at least 30 minutes each day This is at least as important as all of the other rules. Not only must you take in less calories but you must use up more calories. Exercise will improve your general health as well. Initially, while you are severely obese this can be difficult, but, as your weight decreases, it becomes easier. As you become fitter and healthier, you get greater enjoyment from exercise.

We understand that not everybody is sports minded and exercise may be something quite new for you. Start slowly and seek to build up activity progressively. Aim to put together 30 minutes or more of moderate intensity physical activity on most and preferably all days. Walking is ideal to start off with. As your fitness improves, progress to more vigorous walking and even jogging, cycling, aerobics, swimming, and light resistance training. As your weight comes down your exercise capacity will increase and your general activities during the day will increase. This is to be encouraged and the more active you are the better the result will be.

Your exercise program should be aerobic. You should be puffing and, if you check your pulse, generally it should be up around 120 – 140 beats per minute. There are a wide range of activities that will allow you to achieve this. If you can manage it, a personal trainer or fitness consultant can be an excellent assistant. They can provide an individual program according to your specific preferences and lifestyle that is realistic and achievable. Regular exercise requires commitment. The more effort you put in, the greater benefits you will see and feel.

7. Be active throughout each day Think of movement and activity as opportunities and not as inconvenience. Try to be active every day in as many ways as you can. Make it a habit to walk or cycle instead of using the car. Become active in the garden and do things yourself instead of using machines. Avoid sitting down at all cost. You should see sitting down as an opportunity for activity lost.

Try to spend as much time outdoors as possible. We tend to be more active when outdoors. Use a pedometer as a stimulus to you to show how your activity level is increasing. If you are using a pedometer, aim to get beyond 10,000 steps per day – this represents a very good level of routine daily activity.

8. Always keep in contact with us We want to follow you permanently. There will never be a time when we say that the job of controlling your obesity is done and we do not need to see you anymore. There will always be a need to check your progress, monitor your health, check for nutritional deficiencies, make sure that you understand the rules, bring you up to date with new developments and adjust the volume of fluid in the band.

There is always going to be a very small loss of fluid from the band over time. For example, if you had 3 ml of fluid present and we checked the volume after a 6 month gap, there would probably be about 2.7ml present. This occurs because the balloon of the band is not totally impermeable. If 3 ml was the correct volume, you would be starting to get hungry and eat more with a volume of 2.7ml. It is important you understand that this can happen and come back to see us for replacement of that small loss. This is the main reason that we want a maximum of 6 months between appointments.

The LAP-BAND Solution—A Partnership for Weight Loss is available from www.thelapbandbook.com and Amazon.com, and may be ordered at your local bookseller.

April 2008

Glad that soemone was able to find you some info on your procedure.  I swear these procedures are always changing and it's tough to keep up with the latest info. BUT....I have real concerns with what was written.  Specifically "golden rules" 1 and 2.  Your lapband is not much different than my procedure with respect to decreasing the size of the stomach.  The only real difference is that I mal-absorbe.  But, one of the worse things you could do is not eat.  Breakfast is EXTREMELY important to the metabolism - it gets it going in the morning - hence the name breakfast - to break a fast.  Many studies show that those who do not eat breakfast are more likely to be overweight, or regain the weight they have lost. Eating keeps the body out of starvation mode.  When we go into starvation mode, the body will begin to retain everything with anticipation of not eating again.  Thank mother nature and cavemen for that one. I do agree that your meals need to be small, and well balanced - you need to get the best bang for your nutritional buck because our stomaches are so much smaller.  But, to not eat is a major no-no.  I also agree with the small plate concept.  I've been doing it for many-many months and it's worked wonders on my visualization. Now, the next thing is no snacking - again...I disagree (along with many-many studies).  We need to snack.  It's what keeps our bodies going.  And if you are diabetic, you HAVE to snack. And, snacking is what keeps our bodies from fatiguing out on us as the day progresses.  It would be like driving all over town and never putting gas in the car.  Evidentaly your car will stop running - even if you are driving the speed limt the entire time. Eating snacks keeps our blood sugar from plummeting and keeps us in balance.  You just have to use portion control and again....get the most for your nutritional buck. So, while I agree with the other rules, these two, I simply cannot as there are way too many studies out there that tell us otherwise. Sorry .........

Hi ya cutie!!!  Believe me...I totally agree with you.  Actually I was in a rush to put that up with the intent of coming back with my own anaysis of it..I guess I should have waited til I had the time to put ALL my thoughts down.  Not very responsible reporting on my part & for that I appologize.  Everything you said about skipping meals, especially breakfast, is correct.  And for us diabetics, that & not having nutritional snacks are a major no-no.  That's an area of dispute between me & my Nut. which I will once again address with her when I see her next Wednesday.  The only other one I personally have a problem with was under the exercise heading where it said to get the heart rate up to 120 to 140.  Ummmm, for me that would be a NOOOOOO!!!  My defibrillator & set to go off at 165 so to get it up that high would be inviting disaster.  I really don't enjoy going into v-tach & getting zapped.  So some personal modification to one's own situation, not to mention dismissing the advice to skip breakfast, or any meal for that matter, is needed here. Other than guidlelines or Golden Rules, perhaps these should be called strong suggestions to be blend with common sense & health necessity.  Would you agree?  Thanks for catching those before I could.

Aawww....come on.....a little zap to get you going int he morning may be just what you need - HAHAHAHA [all said with GREAT love!]. But, i agree - for many, that hear rate might be too much of a challenege.  Especially if you have not exercised and/or are severly obese. It's just slightly over 65% (for a person my age), which is acceptable, but really does not account for the person's physical fitness level. The article should have come with the disclaimer.....check with your doc first!

Ok, ya know what?  I'm about to just delete this whole thread (sorry Jen...I know you were trying to help).  There's just too many holes & variables in it for them to be so adamant about THIS IS HOW YOU MUST DO THINGS.  Frankly, considering where it came from, I'm shocked at the lack of responsiblity on their part.  I'm gonna have to think about this while I'm waiting to see the doc today.  But thanks for being my sounding board, Jill.  You're so amazing....can I have your autograph? LOL

Now everyone knowing what strong opinions I have must have known I was biting my tongue to keep out of this one!!!! But some of this information is just plain irresponsible - not on your part Anne, but on theirs for even suggesting three tiny meals and no snacking etc - As a former diabetic I know how important it is not to go too long without earing something!! Exercise levels etc - they made those into broad statements with no disclaimers at all!  And no breakfast??? Long time since I have seen professional nutritionists say that!! Okay not going to get started lol!! So thank you Jill for saying everything I would have said!! And Anne - thank you for raising MY heart rate today lolololol! Jackie

Ummmm, how in the world will you get adequate nutrition in 3 meals (or fewer?  no breakfast?wha????) when each meal is supposed to be about half a glass? 

Boy am I glad you all chimed in on this one. I was really starting to second guess myself! I thought I was doing so well. After having my blood sugar drop to 52 this past weekend, I'll second and third, that diabetics need to have more frequent mini meals. Diana

Ya know, I didn't read this whole thing before I sent it to you. Wow! I wish I had, but the road is paved with good intentions. And this info came straight from this OH site too!

No worries, Jen...I know you were only trying to help.  I, too, shouldn't have rushed so quickly to post it here.  I guess at first glance, just scanning it, it sounded ok.  Certainly fed into my feelings of failure & inadequacy...again, not YOUR fault.  I think perhaps I should write to OH myself & ask them if they even screen this stuff they put out...apparently NOT.  Kinda ticks me off too because we are all so vulnerable in this journey...always looking to learn & to keep up with current research.  I guess it just once again reaffirms my belief that we can't believe EVERYTHING the so-called professionals try to shove down our throats...no pun intended.  I take that back...I'm not KINDA ticked off...I'm downright PI$$ED off!  As if I'm not already struggling with self-sabotage...I don't need them to help me down that road.   GGggggrrrrr!!!!      So, fellow lap-banders, please disregard this post.  In fact, do the opposite of everything it says.  Again, I'm sorry for being so irresponsible myself...I should have waited until I really had time to digest it all first.