The best thing since sliced bread

I recently received an unexpected package in the post. It turned out to be a free sample of a new cookie developed by Weight To Go. 'A diet chocolate cookie', I thought, 'how marvellous!' A day or two later I found myself peckish and remembered the cookie. As I tore off the silver foil wrapping I couldn't help noticing how heavy it felt - dense and solid - not like a normal cookie at all. I glanced at the nutritional information and was horrified to see that this mere cookie would set me back more than 400 calories. Granted, it had a higher proportion of protein and fibre, and less saturated fats than a 'standard' cookie, but at a whopping 400+ calories this was not just going to be a snack, more a meal replacement.

I bit into to it and discovered it had the density of a car tyre, and was as chewy as molten rubber. The taste was a mixture of yoghurty, chocolatey (but only slightly), burnt egg white! Now, I'm willing to eat stuff that tastes and feels really nasty if the nutritional benefits are there, but this thing not only weighs half a tonne, it has more than 400 calories in it! It might have lots of protein and fibre, but surely I'd be better off eating a banana? In fact I'd probably do better, calorie-wise, eating a banana dipped in chocolate sauce to be honest! Sorry, Weight To Go, but this is a case of tear up the recipe and start again.

That said, the Weight To Go shakes are, for me, literally, the best thing since sliced bread. I NEVER start my day without a strawberry shake, and over the past four years they've solved a life-long problem I used to have with eating breakfast - namely - I didn't! They're not cheap, but for anyone with a gastric band who finds it difficult, like me, to eat solid food in the morning, then these shakes provide the perfect protein-rich kickstart to the day (along with a mug of strong black coffee, of course!).

Some advice to a potential bandit

After a previous post, a reader posted some questions to help her decide whether to go ahead and have gastric band surgery. I posted my answer as a 'comment' but I know some of you may not read the comments section - so here it is:

I'm pleased that you find the blog useful and helpful. I will try to answer each of your queries - but do remember that (a) this is only based on my experience - the experiences of others may vary, and (b) I'm not a doctor (well, not a medical one anyway!)!.

Loose skin: Yes, I have loose skin and it was one of my greatest fears before I got the band. However, it is much less of a problem than the health problems, humiliation and lack of fitness that go with being obese. I will need to have a tummy tuck and am considering other cosmetic surgery too. However, you are only 22 years old and your skin will be much more elastic than mine (I'm 45 years old). That means it is more likely to 'spring' back into position after you have lost weight. Therefore, you should have a very good chance of not getting excess skin after weight loss. You can do lots of exercise and muscle toning activities,and there are also lotions you can apply to help keep your skin taut. I'm not sure how much these are effectve. The main factors are how overweight you are, your age, and how rapidly you lose weight. You are young, you're not as heavy as I was when I started out, and people don't tend to lose weight too rapidly with the band (compared with a bypass, for example).

Diet: In theory, it shouldn't be necessary to 'diet' with the band. It is not about following a special diet; more about healthy eating, good nutrition and portion control. However, I find that my willpower is so weak that I need to count calories and keep a rigorous food diary to keep me on the straight and narrow most of the time. Most of my meals are healthy and portion-controlled. I also tend to have healthy snacks most of the time. However, I also slip up on a regular basis - yesterday, for example, I managed to fit in two bars of chocolate and a mince pie....!

Multivitamins: I take a daily multivitamin - just a common off-the-shelf variety from Tesco. I use a chewable one. I can swallow small tablets but prefer the chewable ones anyway - they are much like eating a sweet! As a bandit, you should find that after the initial liquids only phase, you can eat a fairly normal diet - albeit with much smaller portions. Therefore, it is not usually necesary to take any other supplements as it is if you have a bypass. I don't use any effervescent tablets but I could if I needed to - I am still a regular drinker of Diet Coke. As long as you pour it into a glass to allow the worst of the gas bubbles to escape, and drink it slowly and carefully, - I've never had any real problem.

Thank you for your kind words. I do hope that your surgery goes well. Do make sure that you get a good aftercare package that includes follow-up appointments, fills and an emergency number just in case you need it. I've never needed to use the emergency number given me - but it's a great comfort knowing that there are people available should anything go wrong. I've just read about a lady who had her op done in Belgium and her surgeon os only over in the UK once a month. She urgently needs a de-fill but has to wait a month for it - I, and some other bandits have advised her to get a de-fill from somewhere else and not wait. So - make sure you get a good aftercare package included with your surgery!!

All the best, Trees x

Pre-band fears part 3: Being called a cheat!

I suppose it was the 'outing' of Fern Britton that did it - she was 'found out' with the gastric band and called a cheat in the British media. I suppose that in the early days of the band I didn't know enough about how it would work so I think a part of me believed that there was an element of cheating involved. Of course now I know different. I know from experience that if I want to, I can eat pretty much anything. I can eat all of the unhealthy foods that I used to be able to eat. I can eat chocolate in volume and binge on the stuff almost as easily as I used to. I know that other famous celebrities gave had their band removed because they gained weight eating loads of chocolate! I know from months of hard work that band success means careful calorie counting, rigorous maintenance of a food diary, tonnes of exercise and constantly making good, nutritional food choices. It means sticking to a whole heap of rules, like chewing everything to death, eating slowly, not getting distracted while eating, using small utensils, eating off a side plate, practising environmental control and balancing proteins, carbs and veggies. It also requires sticking to the hardest rule of all, which is not to drink for at least one hour after eating!!

Because I was uncertain about how the band was going to work, I was careful early on not to tell anyone except my husband, that I had a band. Over time, and as I've learned more about what is involved in making the band work for me, I've become more relaxed about telling people. I guess I feel more confident that I am not a cheat! I feel I can explain to people properly how the band works and I can justify my reasons for having one. Some would say why do I need to justify anything to anybody - but that's just the way I am!

About six weeks after getting banded I told my immediate family. Since then, I've told several close colleagues and friends. Even just today, I told my office mate (as he was stuffing his face with a muffin!). Whereas many months ago I couldn't really see myself telling anybody, now I firmly believe that I will probably eventually tell everybody! I think that basically I'm just a coward, and am scared of telling people in case it doesn't work. That's why I expect I will eventually 'out' to everyone only once I reach my target!! I said I was a coward!

So, as far as people calling me a cheat is concerned - I no longer have that fear. At the end of the day, it's my body, my money and my health. As is plainly clear for anyone who knows me to see, the band has done wonders for me and it clearly does work. If having something that only does 30% of the work is being a cheat - then I confess to being one. But I jest. I am not a cheat, I don't feel a cheat, and anyone who thinks I am one is plain and simple WRONG! There.

SO much to remember!

I used to think banding was simple - it restricts your stomach, you can't eat as much, you feel full sooner and for longer. Oh if only it were that straight forward! Here are a few of the 'rules' I have to remind myself of daily:

1. Eat three small meals per day
2. Chew everything to death and eat small pieces
3. Don't drink after eating
4. Use small utensils and a side plate for meals
5. Practice environmental control
6. Keep reminding your husband to hide the baguette and biscuits
7. Take a bagful of food with you to work every day (breakfast cereal, milk, orange juice, Actimel, lunch, healthy snacks)
8. Write everything down - food, calories, drinks, exercise, steps.....
9. Make sure plenty of your meal is made up of protein to keep you feeling full for longer (it takes away the hunger)
10. Don't overcook the vegetables - the crunchier the better
11. Beware when eating fruit with skins or peels - eat extra slowly and not in front of everyone (hiccups can be violent)
12. Take healthy snacks to work - better than eating chocolate
13. Keep reminding your husband to add healthy things to the shopping list (fruit, yoghurt, cottage cheese) - and to remove things that are too tempting (biscuits and baguettes)
14. Drink, drink, and drink some more
15. If you think you're hungry, have a drink first - then eat if you still feel hungry after half an hour
16. Is it real hunger or just head hunger?
17. If you start thinking about chocolate, do something to distract yourself.... (MUCH easier said than done)
18. Keep reminding your husband not to bring you a cup of tea immediately after you've eaten
19. Worry about whether you've got the right level of restriction at least every five minutes......
20. Remember to cook a double portion of dinner so you can take half of it to work for lunch the next day
21. Cook meals that are nutritionally balanced
22. Take your daily multivitamin, and calcium tablets, oh, and lactulose occasionally......
23. Stop buying huge amounts of fod on the weekly shop - it will end up going mouldy
24. Get excited about strong restriction in the morning - and then get disapointed when it wears off in the aftrnoon
25. Find time to walk
26. Find time to go to the gym
27. ...or do anything else physical
28. Keep reminding your husband to put most of the bread in the freezer - I can't eat so much these days so it will go off if left in the bread bin
29. Refrain from getting annoyed when every other person you see asks you, in a loud voice, how much you weigh....

Oh I could go on! There are so many lessons to learn in living with the band but it's just impossible to keep them all in your head at the same time. So as fast as I remember one lesson, I forget the rest. Today, I went to work with what I thought was a lovely lunch (leftovers from last night - but nice, nonetheless). However, whereas last night I put quite a lot of low fat melted cheese on it - today I didn't. The result was a very bland meal with absolutely no fat in it, unappetising and completely lacking in protein. End result? One hungry lady mid-afternoon - looking for snacks and 'nice' things to eat.....

When will I ever learn?!!

Eggs is eggs

As sure as eggs is eggs, eggs produce, shall we say, a binding effect in me! Having been away for a few days, I was rather at someone else's mercy when it came to food. I ate breakfast each morning in a canteen offering fairly typical English breakfast fayre. On offer were scrambled eggs, fried eggs, sausages, bacon, baked beans, tinned tomatoes and hash browns. There was also toast made from white bread, yoghurt, fruit, and croissants. Being a vegetarian and trying to avoid fatty food, I opted each morning for a piece of toast, a small amount of scrambled egg and a tomato. I also had a yoghurt and took a piece of fruit for later.

From a calorie and nutritional point of view my selection for breakfast was good. However, in the past few days I have experienced one of the downsides of my choices. Eggs seem to have a bad effect on my digestive system and seem to 'block it up' solidly. This morning I declared war on my bowels! I started with the Lactosol, then followed it up with strong coffee, a bowl of All Bran and a banana!! Within the hour I had won the war but was feeling truly knackered!! Sorry if this is all too much information - but it's just one of the practicalities we have to face with the band!

I have a plan for the next time I go away. I'll eat the eggs some of the time, but I'm going to take some All Bran with me and work really hard to boost my fibre intake. For now, eggs are off the menu for a while!!

Why carbs are good

Dr Ashton, Director of Healthier Weight, has written on the HW web site about the dangers of ketosis (click on the title link). This is essentially when the body obtains its energy, not from glucose stores, but by burning stored fat. Now you might think this is a good thing, and indeed fat-burning is not a bad thing in itself. However, when taken to extremes and for long periods of time, it can result in changes in blood chemistry that can be dangerous. A recent case was reported where a lady died as a result of ketosis brought on by following an 'extreme' diet.

Some ketosis is inevitable when we reduce our total calorie intake and carbohydrates. However, fat burning can be taken to serious levels on very low carbohydrate and / or low calorie diets. My observation from looking at some American web sites and reading weight loss books that come out of the US is that they appear to be much more keen on carb-free diets than us in the UK. Nevertheless, there are an increasing range of carb-free diets available and they are DANGEROUS!! How come people don't realise that our bodies need a balanced diet, with elements of proteins, carbs, fats (yes, they're not called 'essential' fats for nothing!), vitamins, minerals and fibre. If any one of these is missing the body will suffer.

Of course, some carbs are better than others. Simple carbs (sugars like chocolate, sweets) are the bad ones. The middling ones are potatoes, white bread, rice and pasta. These are complex carbs that are refined. The best carbs are complex and unrefined, like wholemeal bread, pasta and rice. These should form a component of every meal and make up about one quarter.

So there you have it. Carbs are very bad if you don't have them, they can be bad if you have the wrong ones, but if you have the right ones they're very good for you!

Is dieting necessary?

A couple of days ago a reader posted a comment which posed some important questions. In my attempt to answer these I somehow almost deleted the original post and comment and couldn't get it back again - as a comment. However, I did have a copy on my clipboard (phew!). So, since there were some important questions in there anyway I've posted the original comment and my response below. I do hope this was OK by you Amy - thanks so much for your contribution:

Hi Theresa,

I am an avid reader of your blog - has been marked under favorites forever! I have only commented once, though....I love reading about your progress - you are a very approachable writer, if that makes any sense. Anyway, I am wondering if you could be your eloquent self and answer this question....I was banded on June 22 and had my first fill on August 12 - 7ml in a 10 ml band. Before the surgery, I asked my consultant, if he had to use percentages, what percentage of my weight loss struggle would be my own burden, and how much of the struggle would the band take care of? I hope that makes sense to you...he answered he thought the band would do about 75 percent of the work. My question to you is....since you have lost SO much in 9 months, how much of the work did you do, and how much was the band? Your loss has been amazing, and it is early days for me yet, but I am having to overtly and actively "diet" to lose....Your weight seems to have come off very steadily and consistently ...I just had to ask you to try and see your success formula. Again, how much effort was you, and how much the band? Thanks for trying to make sense of the question for me....Amy

Hi Amy,

Thanks for your kind comments and for being such an avid and loyal reader - it's nice to be reminded from time to time that there are actually people out there reading this labour of love! To your question:

My provider, Healthier Weight (Dr David Ashton), liken weight loss with the band to a three-legged stool - remove one of the legs and the stool falls over (ie the band 'fails'). The three 'legs' are (a) the band and the restriction it provides, (b) the calories that go in - what WE put in our mouths, and (c) the calories that go out - through exercise. Using this analogy the band does one third of the work and we have control over the other two thirds. David Ashton told me at my consultation that I would have to do 70% of the work and the band would do the other 30%. These percentages are regularly cited on the UKGastricBand forum.

I think I put in very little of the effort during the first two months post-op because I was swollen and bloated and dealing with healing rather than weight loss. Nevertheless I lost quite a bit of weight during that time. The next five months were the toughest for me because it took a long time to get restriction (many people get it early on but I was not lucky in this respect). I complained a lot that the band wasn't keeping up it's end of the bargain and doing its 30%. I felt I was having to do most of the work by sticking to the band rules, doing lots of exercise and being disciplined. Just as I began to run out of steam I started to get some restriction at last. The last couple of months have been a bit up and down because the band is definitely providing some restriction now, though I am clearly nowhere near as tight as some others, but holidays, celebrations and meals out have disrupted my flow somewhat.

However, through these various ups and downs, I think what has helped me achieve fairly consistent weight loss has been that I decided, right from the beginning, that I was going to change some critical eating habits. These include:

1. Always eat off a side plate and use small cutlery
2. Eat slowly, avoid distractions, chew chew chew!
3. Don't drink for at least one hour after eating
4. Don't put gravy, sauces, mayonnaise etc on anything - keep it all low fat and dry
5. Eat carbs, proteins and veg/fruit in approx equal proportions
6. Practice environmental control - remove from the house anything that isn't nutritious and healthy
7. Aim to walk 10,000 steps per day (don't go anywhere without a pedometer)
8. Keep a food diary - weigh everything, count calories, write it down

Some of this has been a right pain (!), but it's been worth it. It is said that if you do something (whatever it is) for six weeks it will become a habit. It's true. For example, I no longer have to even think about eating slowly it just comes naturally.

I understand that you, indeed I, don't want to diet now we have a band. But I think there is a transitional period between the op and reaching that ideal restriction. If this period is short then lucky you! If it's longer, as it has been for me, then there is a choice - either maintain weight (or even gain) until you get restriction, or use that time to get into good habits and 'do your best'. If like me you continue to lose weight during that time then that's fantastic - but it may mean semi-dieting to some extent.

Gosh I've rambled on (hardly eloquently either!) - I hope that goes some way to answering your question. If it doesn't or you want to ask other questions, PLEASE ask away! I wish you all the best. Just remember this is no quick fix, it's a long haul (I have to keep reminding myself of that), and a key success factor, in my opinion, is getting into good habits early, and putting these good habits into practice most of the time (probably about 80% of the time in my case - I'm no angel!).

Theresa x x

Early post-fill update

Well, so far I have gone from fluids-only onto mush - and I know it's far too early to give any definitive post-fill status, but I thought it might be useful to describe some of my eating experiences since my fill on Thursday. I stuck fairly rigidly to fluids on Thursday evening, Friday and during the day on Saturday. This time, I was too lazy to make my own homemade soup as I have done on previous occasions, and so ate Weight Watcher's mushroom soup (with the mushroom bits sieved out!) and Weight-To-Go parsnip soup. I had a couple of soups each day plus strawberry shake. To make the latter more interesting and filling, I blended in banana, milk and apple to make a really nutritious drink. I've also been drinking lots of black tea, low sugar Ribena and water. However, on Friday and Saturday, I found it impossible to consume what I consider to be enough calories per day (i.e. about 850 as a minimum, but ideally 1000). So I did what I have done previously while on the fluid phase, and sucked some chocolate!! I consider this my reward for surviving on soup only and it does no harm - it boosts my calorie intake to a more acceptable level and hey, chocolate does have some nutrition in it!!

I've had a little extra gurgling in my throat when I swallow drinks - particularly in the morning. However, it's nothing like as bad as it was on the occasion when my fill was too tight, and I think it's a common experience for most people during the first few days after a fill. I have not had any vomiting or slime, though I had a hint of slime coming on, on the first day after a I drank some shake. What I have noticed is that it defintely takes me longer to consume anything in the morning. On Friday it took me about an hour to drink a cup of tea and a glass of orange juice!! However, this has reduced on Saturday and Sunday mornings. I find it helps if I have something warm or hot first (like tea, soup or low fat creamed rice), and then have cold drinks like orange juice and/or shake. Having said that, this moning my breakfast drinks went down at near-normal rate (with tea first, then orange, then creamed rice).

On Saturday evening I moved back onto mush and had mashed potato, scrambled egg and some baked beans for dinner. This all went down very well with no problems. I did my usual and ate it quite slowly, taking about 30 minutes. I also chew everything well before swallowing and eat off a 7-inch side plate. After eating this I felt pretty full and did not want or need an evening yoghurt.

Today (Sunday), I had low fat creamed rice for breakfast and orange juice. For lunch I had a Weight-To-Go smoked haddock and potato meal which was lovely. I made certain that I chewed the fish well and had no problems getting it down. I was really quite full afterwards and didn't start to feel peckish again for several hours.

So, in a nutshell, I still don't really know whether I have good restriction yet because I am still eating soft, slider foods. However, I am relieved that I am not too tight and in need of an aspiration - particularly since I now have more fluid in my band than I had previously when I did need an aspiration! The signs are good for restriction but I'm not getting too excited yet. I cannot wait until I get back onto proper solid foods to see whether I am anywhere near my 'sweet spot' at last!!

Protein boost

I've decided that I need to eat more protein. I'm taking a leaf out of the American's book and trying to boost my protein intake, partly just to make sure I get enough bone and muscle-supporting vitamins and minerals, but also because protein makes you feel full for longer compared with carbohydrate and veggies. Since my last fill I have had some restriction but it seems to be quite variable. I have noticed that I am often getting hungry early afternoon but not in the evening. So, I am going to boost the size of my lunches and include more protein, in the hope that I will be able to keep going till my evening meal without too much trouble.

I tried this strategy yesterday and today. Today, for example, I ate salmon with Philadelphia cheese on it, boiled potatoes and sprouts. This was incredibly filling and my 'full' feeling lasted from lunch time (about 12.30pm) till 8pm this evening when I ate my dinner! Yesterday, I ate vegetable chilli (packed with loads of protein-rich beans) and prawns (also high in protein). That also made me quite full until I had my evening meal.

I am going to continue to make a concerted effort to boost my protein intake and the size of my lunch over the next week or so and monitor how it goes. I am cautiously optimistic that with this sort of regime, I may have achieved a decent amount of restriction at long last.

Carbohydrate cycling

Apparently, the carb monster is not necessarily a mental demon. The carb monster is the body's biological roller coaster that results with a blood chemistry imbalance. More often than not it has nothing to do with willpower or personal integrity. According to Drs. Richard and Rachael Heller in Carbohydrate Addicts, blood sugar swings are the leading physical trigger for carb cravings. They write, "High-sugar, refined starch, convenience and comfort foods feed the (carb) addiction like a drug. They produce correspondingly high blood sugar and insulin levels, which leads to more cravings. They also produce higher levels of the brain chemical serotonin. In sensitive people, particularly those who may have low serotonin levels to begin with, a carbohydrate binge is the equivalent of self-medicating, just to get the sugar high.”

So that explains why it is that I'm OK if I don't eat chocolate for weeks. But if I do eat one little morsel of it, I want (need?) more, and more and more........

According to The Merck Manual of Medical Information, “The theory behind high protein, low carbohydrate diets is that slower-burning energy sources – protein and fat – provide a steady supply of energy and thus are less likely to lead to weight gain. In addition, people tend to feel full longer after eating protein than after eating carbohydrates, because carbohydrates empty from the stomach quickly and are digested quickly. Carbohydrates also strongly stimulate insulin production, which promotes fat deposition and increases appetite.”

So that's why some bandits place such an emphasis on eating proteins indeed many American bandits have four band rules, the first of which, is "Protein First").

Marks and Sparks food

I'm staying with my family in London over this weekend, which partly explains the absence of a post yesterday. I had a long drive down from Friday evening and decided to drop in on one of Marks and Spencer's 'Simply Food' outlets at a motorway service station. They really are the 'bees knees' for bandits trying to eat good quality, low fat, nutritious food (and no, I don't work for them and I'm not on commission!). I only intended spending a quick couple of minutes in there to buy something that I could eat on the journey, but ended up taking about 20 minutes browsing around shelves of wonderful food! In the end I bought four items: a small pot of soya beans with rocket, pine nuts and chilli dressing (210 calories); a pot of prawns with low fat mayonnaise and salad (165 calories); a larger pot of sun-dried tomatoes with orzo pasta and spinach (350 calories) and a pot of mixed fresh fruit containing slices of pineapple, blueberries, raspberries, mango and kiwi fruit (125 calories). I ate the prawn salad and fruit for my evening meal (total 290 calories) last night. Today, I ate the bean and chilli salad for lunch. This evening I mixed the tomato and pasta salad with some steamed salmon and chopped courgettes, heated it up, and ate half of it (total 320 calories) - I'm having the other half for lunch tomorrow (can't wait). I have to say, all of the food I purchased at M+S has been absolutely gorgeous.

Not only does the food taste great, but all of the pots that I bought were really well balanced - nutritionally-speaking. They each had some protein, carbohydrates and various vegetables. M+S also provide lots of information on the packaging setting out exactly what's in the food, calories, fats, carbs etc. The food is also set out really nicely so that it actually looks good too. I'm raving about this food because it really was soooo nice, but also because I have competely failed to find any ready-made, low calorie, nutritious food anywhere else?! Everywhere else I have looked I am invariably offered sandwiches or wraps laden with mayonnaise and huge chunks of cheese, or high fat options such as houmous or fried foods - and there's often no calorie information available. When you start to look, it is actually quite difficult to find ideal bandit food that is ready to eat on-the-go - while travelling, for example.

I suppose the obvious answer is for me to prepare my own food. However, before I embarked on my new 'think-thin' lifestyle, I believed that not having to always prepare my own food was somehow a reward for working hard. The logic is, you work hard to earn some money, and then part of the reward for your efforts is to be able, sometimes, to relax and enjoy food prepared by someone else. In the past, this 'food prepared by someone else' was invariably bad food - the kind of sandwiches and fatty foods I referred to above. So, in this new lifestyle, I am determined to carry this notion forward - at least some of the time. If this means planning my days around proximity to an M+S store, then so be it!!