There is a way to eat with Lap-band surgery that will maximize weight loss

Knowing what to eat is one part of it.  Learning how to eat is another. Ever since you threw that first bowel of  Cheerios at mom, you have known how to eat.  But with the band you may need to re-learn how to eat. When it comes to eating, we want you to think: slow, small, and easy.  

The typical "guy" eats food this way: no or minimal breakfast, no or minimal lunch, some afternoon grazing, and shoveling in 2000-3000 calories at night.  Chomp, chomp, swallow. Many of my patients, before surgery, describe that they will go all day without eating then go home and mindlessly shovel in 2000 to 3000 calories  in front of the television. That won't work with the band. This is not an easy concept to put into practice -- but practice is what it takes.  The band is designed to have two to three small meals and a snack -- it is not designed to have less at dinner.  

So the two concepts to learn are:

  • You will need to change from eating a single large volume meal to eating several times with small volumes
  •  When you eat -- again, slow, small, and easy.

By eating slowly you allow your brain to catch up with your stomach...

...and there is less of a tendency to overeat the band.  Even if you are not paying attention to the amount of food you are consuming, you are in less danger of overeating if you eat slowly than if you are eating fast. By eating slowly, you will have a better understanding of the volume you eat -- you become more conscious of the amount -- and it is easier to avoid the problem of overeating by eating slowly.  You get a chance to enjoy what you are eating.

Eating small bites is one way to eat slowly.  It expands the number of bites you take with your smaller meal.  It allows you to savor the food, instead of eating large quantities.  Dogs eat fast, probably in their nature, and when eating a steak and giving the dog a piece of it they almost swallow it, and I am tempted to ask, "Did you taste that?"  Eating small bites also fools the brain a bit.  By taking a longer time, it allows your band to see many bits of food go by then signals the brain  that you have eaten a lot and the appetite is suppressed.

Savoring food is a new experience for many band patients -- enjoying every bite and enjoying the food for how it tastes, the texture in the mouth, and the aftertaste it imparts.  The difference between a bandster who is successful -- by savoring food -- and one who is still trying to quickly consume calories is much like the difference between someone who enjoys a glass of wine and someone who does shots of Tequila to get a buzz.

Taking it easy when you eat is another reminder to "slow down" and enjoy the company you are with. There has been a lot of research about eating out -- and how that there is often a "pace setter" for the group.  Making a conscious effort to slow down, to eat less, and to talk with the company around you can make for a far more enjoyable meal.  Ever eat with a thin person -- they seem to pick at their food and play with their food a bit more.  It is OK, enjoy the conversation.  If eating is a social occasion then be sociable - -you do not have to be a hyena afraid some other pack member will eat more than you.

Another part of slow, small, and easy is using smaller utensils

 --such as a salad fork, or the fork that is used for fish helps you to take smaller bites without much effort. It is hard to put a large piece of meat on a small fork.  Another way is to use chop sticks -- you eat smaller bites and it helps to slow down the intake.  I still have not figured out the soup part with the chop sticks.

Use a smaller plate.  Smaller plates make the smaller portion seem better. If a small plate is full, a person tends not to feel deprived. Brian Wansink wrote a great book called, "Mindless Eating."

Portion size is perception -- so to not feel deprived, to eat slower, use a smaller plate. This is also known as changing your environment.

Food can become lodged in the stoma...

...resulting in a discomfort, regurgitation, vomiting, and even an acute band slip. Often this comes from either eating too fast, or swallowing too large a piece of food, or not chewing enough,  or sometimes the type of food can become lodged in the stoma (the opening between the pouch and the lower stomach). 

The opening between the upper pouch and the rest of the stomach (the stoma) is fairly small. But swallowing too large a bite will not allow the upper stomach to push it through the stoma.  If it sits on top of that opening, blocking it, the result will be food that feels stuck.  When this happens, you can feel a pain in the chest, and even  become short of breath, and create a lot of saliva and mucous (the body's attempt to lubricate the food through the stoma).

There are two ways that band patients avoid this problem.

One is to chew a lot.  This used to be called Fletcherization.  Horace Fletcher was a health food faddist who believed that food should be chewed thirty two times (or 100 times per minute) before being swallowed. He was given the nickname "The Great Masticator."  He did have a couple of bits of wise advice for the band patient -- such as never eating while angry or sad and not to eat until being "good and hungry." However, we do not recommend not eating until you are good and hungry -- as if you are too hungry the tendency is to eat too quickly.  Over chewing is not the best way to avoid food becoming stuck. Even the tastiest of food can be chewed to a tasteless pulp -- losing the real enjoyment of food. Over chewed food can become so broken down that it will go past the stoma and into the lower pouch -- much like water or soup -- and not allowing the band to do its job.  When food goes through the stoma quickly, there is no satiety, no appetite suppression.  Everyone has a different number of times that  they normally chew food -- for me it is five or six times, for my dog three, for my old neighbor in Alaska -- well, he chewed everything 28 times (when you are a kid, you can't help but notice, and when you are a bored kid with adults, you count).

The second way to avoid it - is instead of over chewing, it is better to cut your food into smaller pieces so that it is unlikely to become stuck.  Cut food to the size of the fingernail of the pinkie finger, or the size of a pencil eraser.  If the food you put into our mouth is smaller than the pencil eraser, it is unlikely that it will become stuck. More important -- it slows you down.

This is easy with a knife and fork, and a lot harder if you have to eat it directly, like a hot dog. When you cut something into small pieces and then put it into your mouth, it is easy. But if you take a bite of hot dog, you might get into trouble.  First, people tend to take a larger bite than we would recommend. Second, hot dogs, like sausages, are very densely packed  pieces of meat -- don't look at one under a microscope, what they put into the hot dogs are not always the best parts. That dense meat can become stuck in the band and the "skin" of the hot dogs and sausages can also become stuck. Nothing worse than a barking dog on top of a band.  Most hot dogs are not in the "wise food choice" category, but if you are faced with a hot dog, take your time, and take smaller bites.  You could also cut the hot dog up. Not eating the bun or the bread can also help to prevent the dog disaster (Diego, the therapy dog for the practice is looking at me wondering why I use dog and disaster together).

Eating too fast with a Lap-band results in two problems

 First, you can eat too much.  When you eat fast, the brain does not have time to register the signals.  Eating more slowly allows the brain to process the sensation in the stomach. Eating too fast is one of the factors that can lead to a band slip.

Second, eating too fast doesn't allow your natural saliva to mix with the food.  Before banding, many people would eat to excess, by eating too fast, and then washing the food down with liquids. With the band, not allowing saliva to lubricate food may cause the food to become stuck. A person can eat too fast and still chew a lot -- so, pace yourself -- this is sometimes one of the most difficult changes to make.

Food should go down easy.  Food is not to be "choked" down, nor should it be rushed.  Food is to be enjoyed.  One of the hardest things to retrain your mind is that you will be able to eat smaller portions and survive and feel satisfied with those smaller portions. By eating those small portions slowly you will discover that you enjoy the food just as much. If you are in a hurry -- you eat fast, or if you are "starving."  Being in a hurry is a normal part of modern life -- eating on the run, wanting something quickly.  But eating too quickly can lead to over filling, over eating.  Possible band slips means that this is a part of life that is worth slowing down for.  No eating on the run.  No eating in the car.  Take your time and enjoy the meal. You deserve 20 minutes to eat.  If you don't have time to eat a proper meal, you don't have time to lose weight.

There is a syndrome called "First Bite Syndrome," where a person eats one or two bites and the food comes back up almost immediately or they get copious quantities of "slime" created and then they seem to be able to eat almost anything. This happens when a person eats too quickly - forcing food down quickly.  The small upper pouch has two reactions - contract on the food and attempt to force it past the stoma or force it back out the mouth.

Preparation for the day - knowing what you are going to eat and when...

...is the key used by those who lose weight. The purpose of eating three meals a day and a planned snack, is to avoid the circumstance when you feel "starved."  Most people, when they feel starved, appear like a pack of hyenas gobbling down food before the other wild dog gets it. Before banding, you could go all day without eating and then slam down 3,000 calories in the evening. You won't be able to do that after banding.  That behavior is not a healthy way to nourish yourself.

Skipping meals never works in weight loss, and it does not work with you and your band. By skipping meals you risk snacking and overeating later. When you become "starved" you tend to eat too fast, too much, and the wrong foods -- and if your goal is to lose weight and keep it off, this behavior will not work.  Remember when you first were thinking about the band and someone said that there is a lifestyle change? This is part of it -- because the lifestyle you did before did not work. Plan to eat three meals a day, spaced out every four to five hours.  Eating breakfast within a couple hours of arising is a good thing, although some band patients report they are too tight in the morning.  While you may be too tight first thing, planning on having your breakfast later makes good sense. Eating breakfast, even later, is still a good idea, there is a complex "ileal response" (OK, I'm a nerd, you don't have to know the specifics) -- that allows you to have your appetite dimmed later by having some breakfast. Breakfast  often involves drinking some warm beverages first -- coffee, tea, or Miso soup.  Remember, a portion is one egg, not "eggs."

A diet method that was popular was for a person to plan six small meals a day -- which tended to be grazing all day and often resulted in weight gain.  The one element that was missing was to plan.  Three meals a day, band size portions, and perhaps one snack (especially if there is a long time between meals) is all that anyone needs to sustain themselves.  Six small meals is simply a recipe for obesity.

Eat slow, small, and easy -- plan your meals as well as your meal time

Enjoy some great food, and you will find that losing weight, or maintaining your goal is not the focus of mental energy.

Finally, as your band is adjusted you will find that the pouch will rebel if you attempt to "slam" down calories. Too often patients have an adjustment then in a week, or two, or three they come back wanting some fluid removed stating the band is just "too tight."  This can lead to a pattern where a fill is followed by no change in behavior and then an unfill resulting in an endless, frustrating pattern of band adjustments with minimal weight loss. Fill-unfill-fill-unfill-fill-unfill -- this is not a band problem.  This is a problem of someone attempting to adjust the band to habits that led to excess weight.

There is a mourning that goes with this-- old habits die hard. But when you see the successful patient, they have adapted -- they have changed, they have learned the joy of planning, enjoying several meals, and allowing the appetite to be suppressed greatly. The best way to find joy in this lifestyle change is in the smaller clothes you wear.

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