I have to say I was addicted to food also. Well I don't think most of us would qualify for the surgery if we didn't like food. There are for sure foods I miss but lots of the foods it is impossible for me to be able to get them. I have had a few stuck times and now I don't crave those foods because I know how bad that hurts and how bad I feel during it. I could list a ton of foods I couldn't get enough of before surgery and now I can't eat them. My one I miss the most is a chedder bread from great harvest but without that and many other foods I am feeling amazing with me getting healthier!
The liquid diet is a common feature of the bariatric surgery landscape, as widespread and despised as kudzu in the South. Since there’s no way around it, you might as well make the best of it by learning the reasons for it and trying the practical tips I’m going to give you.
WHY A liquid DIET?
Bariatric clinics use differing protocols for their patients’ pre-op and post-op diets. Why? When you finish explaining that, perhaps you could also explain the meaning of life? If you asked your surgeon or dietitian, the answer would probably go something like this: “We have adapted these procedures to suit the needs of the patients in our individual practice, based on our experience of what produces the best outcome and the fewest complications.” In the case of adjustable gastric band patients like us, you might expect the band manufacturers to dictate what are called “best practices” in patient education and care, but the fact is that if Allergan and Ethicon-Endo were to employ armies of band police to supervise every bariatric surgeon in the world, no one would be able to afford a gastric band.
However those clinics’ protocols may vary, the liquid diet is extremely common part of bariatric patients’ pre-op and post-op instructions. Contrary to popular belief, the liquid diet is not intended to torture the patient. The main purpose of a pre-op diet is to reduce the size and improve the texture of the liver (any weight loss is a plus). The liver is a big organ whose left lateral segment lies on top of the part of the stomach where the band is placed. The pre-op diet uses up the glycogen stored in the liver, shrinking it and making it sturdier, less slippery, and easier to maneuver with laparoscopic instruments. This not only makes the surgeon’s job easier and quicker, it also reduces the risk of complications for you. If your surgeon doesn’t require a pre-op diet of any type, I would have to conclude that he or she is mighty confident in their surgical abilities, but I would also want to ask them how often they have to abort a surgery or convert from a laparoscopic to an open incision technique because of problems handling the patient’s liver.
The purpose of the post-op diet is to keep you nourished while you and your upper GI tract recover from surgery. Although AGB surgery is usually minimally invasive (when done laparoscopically), it does require incisions and some internal dissection, as well as manipulation of your internal organs. All this can cause swelling. One day your stomach was fat, dumb and happy. Now it's got a collar around its neck. In order for it to digest food in any form, your stomach muscles must expand and contract to break the food down and move it along to your lower GI tract. Expecting your stomach to do that comfortably and safely while wearing its brand-new collar just isn’t wise.
So to allow everything to heal properly, and the band to seat itself against your stomach in the correct position, most surgeons require patients to follow a staged post-op diet, starting with liquids. What happens if you don’t follow your post-op recovery diet?
Food can get stuck in the stoma or esophagus and cause an obstruction and/or vomiting.
Vomiting can disturb the position of the band, which can cause the band to slip.
Peristalsis (the muscular action of moving food through the digestive system) can disturb the position of the band, and that can cause the band to slip.
So don't do it!
"But I already cheated!" you say? It's not the end of the world, but don't do it again!
"But I'm starving!" you say? That's too bad, but that isn't the end of the world, either. Not, it's not fun, but hunger is not a good excuse for cheating your health in such a major way. I'd guess that seven of ten bandsters starve their way through the liquid diet phase. If you absolutely cannot bear the liquid diet for another second, or you think you might be genuinely allergic to your Protein Shakes (which could be lactose intolerance rearing its ugly head), call your surgeon or nutritionist before you put something in your mouth that isn't on the approved list. And by the way, the same advice applies to following a liquid diet after each fill you get, so you might as well perfect your liquids survival technique now because you’re going to need it over and over again in the future.
SOME PRACTICAL TIPS FOR SURVIVING YOUR LIQUID DIET
Don't worry about how many calories you're consuming, but stay away from milkshakes, ice cream, frappes and fancy coffee drinks.< br>
Drink Protein Drinks (protein will keep you going longer than sugary stuff like fruit juice).
If you don't like the smell or taste of Protein Powder, try putting the drink in the freezer long enough for it to get slushy, and/or put it in a covered beverage container. Sometimes it's the smell, not the taste, that's bothersome.
If you don't care for sweet tastes, try unflavored Protein powder (from various sources including Unjury®) or Unjury® chicken Soup flavor protein powder (www.unjury.com).
Add Unjury® chicken soup flavor protein powder to blended creamy Soups (follow the Unjury® heating instructions or it will clump up and refuse to dissolve).
Add fat free half-and-half or milk to prepared chicken bouillon or broth for a creamy drink.
Add unflavored or fruit-flavored protein powder when making sugar-free Gelatin. Check out the recipes at the Unjury website. Be aware that “unflavored” doesn’t mean the protein has no flavor, so the end product isn’t going to taste exactly like the original.
Buy your favorite soup from a local restaurant, strain out the solids, and drink the broth (Chinese hot and sour soup is wonderful this way).
Buy or make bean soups, puree and thin them with broth, Water, or milk. The pureed soup must be thin enough to pass through a drinking straw.
Add powdered non-fat milk to soups and shakes to boost the protein.
Crunch on sugar-free popsicles, slushies, Italian ice, or ice chips.< br>
Don't hang around people who are eating real food.
Experiment with the temperature of your liquids - cold may feel or taste better than hot, or the other way around.
To prevent boredom, experiment with recipes for protein shakes (you'll find at least a million recipes online).
Keep busy! This is a good time to address holiday cards. Who cares if it’s the middle of June?
AND IN THE TMI DEPARTMENT…
A few final words about your liquid diet. Don’t panic if consuming liquids sends you running to the bathroom more often than you’d like. LIQUIDS IN = LIQUIDS OUT. If that happens to you, ask your doctor to suggest a safe, effective OTC anti-diarrheal medication.
And remember: This too shall pass. In more ways than one.
Is maladaptive eating slowing or sabotaging your weight loss? Let's take a look at how that happens and what we can do to change it.
WHAT IS MALADAPTIVE BEHAVIOR?
The term “adaptation” brings Charles Darwin to my mind. His theory of evolution is considered heresy where I live, but whatever your personal belief about the origin of the human species, you’ve probably observed many times that humans and other living things have an amazing ability to adapt their behavior, and even their forms, to better survive and thrive in its environment, and that as the environment changes, so do the creatures living in it.
Here in Tennessee, the weather is getting hot enough to send us into our closets to bring out the shorts and sandals and bathing suits we need to comfortably survive the summer. At the same time, our dogs and cats are shedding the extra fur they’d acquired to keep them warm during the winter. The humans are adapting their dressing behavior and the cats are adapting their forms to adjust to hot weather. This is adaptation in its positive sense, but adaptation also has a dark side.
Defining “maladaptation” requires us to assume that certain behaviors are normal, while others are abnormal. That does not necessarily mean that normal is healthy and abnormal is unhealthy. Someone (or something) is considered “normal” if they conform to a widely accepted standard or practice, and abnormal if they deviate from the norm.
A behavior can be identified as maladaptive or abnormal only in the context of an environment. It is not intrinsically wrong or evil, and its degree of deviance or abnormality depends on things like cultural and social rules and norms (cannibalism may be a normal behavior in one society, but not in another), systems of psychological and medical thought (a mentally ill person may be “abnormal”, but able to function despite that); as well as political beliefs and ideals (in a democracy, the practice of communist principles is considered “wrong”). I’m going to try to bypass all those interesting but knotty aspects and give you definitions and examples that don’t require a PhD in sociology or psychology to decipher them.
Some maladaptive behavior is disruptive to society because it interferes with group functioning. A child “acting out” at school in reaction to the stresses he experiences at home is an example of this. His frustration with his home life turns into anger that fuels temper tantrums in the classroom. His behavior is maladaptive because it doesn’t eliminate the stresses at home and creates a whole new spectrum of stresses and problems at school as his teachers and fellow students react to his aggression. He can’t learn lessons in school that he needs to learn because his “bad” behavior gets in the way.
Other maladaptive behavior is expressed in an inward fashion. A shy, anxious art student is horrified when her painting teacher publically critiques her painting and tells her and the rest of the students that her artwork is exactly what they should not be doing. The art student loses confidence in her talent and changes her major to another subject. Her behavior is maladaptive because it makes it much harder for her to achieve her original goal of becoming an art teacher.
My own definition of maladaptive behavior is this. It’s a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You adjust to a situation in a way that makes sense at the time but that eventually misdirects your energy and focus, and interferes with your personal and interpersonal functioning, your health, and your ability to achieve your goals. At the start, the behavior feels like a helpful, even positive response to abnormal, difficult, or negative circumstances.
As a bandster, I used both old and new maladaptive eating behaviors. My decades-old behaviors, like eating to deal with stress, did not disappear on the morning of my band surgery, and 5 years later, I’m still working on changing that. I also developed new behaviors in response to the experience of having an adjustable gastric band. The long-term result of these maladaptive behaviors is unintended and undesirable. The maladaptive eating tactic may seem to solve a current problem while it's actually creating future problems: slowed or stopped weight loss, weight gain, band slippage, band erosion, and so on.
SOFT CALORIE SYNDROME & OTHER DANGERS
A classic example of bandster maladaptive eating behavior is known as Soft Calorie Syndrome. I discovered the perils of this syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like Soup, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself.
A frustrating aspect of maladaptive behavior is that it’s often easier to see in others than it is in yourself, but even someone who’s fully aware that her or his behavior is counterproductive may feel helpless to change it. If I had a dollar for every time a bandster has confessed to eating to relieve stress or boredom, I’d be a wealthy woman now. Emotional eating tends to be so longstanding and deep-rooted that it takes on a life of its town, like a devil lurking inside us who seductively whispers, “Chocolate! chocolate will make you feel soooo much better!” when you’re too vulnerable, tired, or upset to make a different or healthier choice.
When I was being treated for PTSD years ago, a counselor asked me to make a list of behaviors and activities that I could choose to do instead of engaging in self-destructive ones. At first the exercise seemed contrived and silly, but eventually I realized its usefulness. I was not able to think clearly and make good choices when in severe emotional distress. All I could think of was razor blades. My index card of alternate behaviors reminded me that I could telephone a friend, go for a walk, take a bath, listen to music, pet a dog, and the like instead of playing with sharp objects.
Now, I very much hope that you’re not dealing with severe emotional distress (which I would wish only on my worst enemy), but I do believe you can benefit by making your own list of alternatives to emotional eating. Carry a copy of that list with you everywhere you go and keep a copy in an easily-accessible spot at home (I tacked mine to my bulletin board).
TRUTH OR CONSEQUENCES
In the 1960’s and 70’s, contestants on the “Truth or Consequences” game show would try to answer ridiculously obscure trivia questions and be forced to perform silly stunts in punishment for getting the answers wrong. The host ended each episode by saying, “Bob Barker saying goodbye, and hoping all your consequences are happy ones!"
The relief or pleasure or other immediate consequences of a maladaptive behavior may seem like happy ones, but they generally short-lived, so the behavior must be repeated over and over for the benefit to be felt. As with an addiction, it takes more and more of the behavior or substance to cause relief or pleasure. An anxious person, whose mother lost a leg to gangrene (death of flesh) from bacterial infection in an untreated injury, naturally fears germs. She washes her hands thoroughly and often, especially after touching anything that might harbor germs. At the start, her own home is clean and safe, but because her hand washing doesn’t remove her basic fear, eventually she must practice it all day, every day, over and over, even in her own home, until her skin is scrubbed raw. She sees the abrasions her scrubbing has caused as more vulnerable to germs and increases the hand washing. Soon the hand washing excludes all other activities and she dares not leave her home. The salutary practice of hand washing has become a maladaptive and destructive behavior.
Unlike the hand washing or other compulsive, fear-based, abnormal and ritualistic behavior, maladaptive eating is rarely perceived as strange. Eating is socially acceptable as long as the meat on your plate belongs to a different species. It’s also something that’s easy to do in secret, while you’re alone in your car or your bathroom or wherever you go to escape other people. But when you do it over and over again, your repetition of the behavior cements it into a wall around you, keeping you locked inside instead venturing forth to find relief elsewhere. And should you confess to this maladaptive eating behavior, people who don’t use food in this way simply cannot fathom why you would do it. They say impatiently, “Put the fork down! Step away from the table! Just say no to chocolate!” Ah, if only it were that simple, that easy…
SMALL-TIME CRIMINALS
Some maladaptive behavior arises from ignorance, misconceptions or misunderstanding. Take the case of Martin. He received minimal pre-op education, so when he found himself PB’ing (regurgitating) on a daily basis after his 3rd fill, he assumed that this was simply a fact of life for bandsters. His problem is ignorance. The same thing happened to Annie, who assumed she was doing something wrong but was too shy, ashamed and embarrassed to ask her surgeon about it. Her problem is misconception. And when PB’ing intruded into Carol’s daily life, she believed it was like vomiting, caused by “a stomach bug”, so it never even occurred to her that her eating behavior might be causing it. Her problem is misunderstanding.
All too often, a maladaptive behavior seems like such a small “crime” – it was just one ice cream cone – that the bandster minimizes its importance without realizing that the cumulative effect of a series of small crimes can be just as destructive as a single big one. It’s kind of like ignoring the posted speed limit when you’re driving your car. You shudder at the news of a fatal car accident when an acquaintance driving at 70 mph in a 35 mph zone loses control of his vehicle and crashes into a telephone pole. In that instance, ignoring the speed limit is clearly a bad choice. But when you’re late for work (again), run a few yellow or even red lights (again), and drive at 70 mph in a 35 mph zone (again) in your eagerness to get to work on time, and nothing bad happens, speeding doesn’t seem like such a terrible crime…until the day you can’t stop in time to avoid the car turning into your path and end up as a bleeding mess choking on dust from your car’s air bag while an ambulance carries off the person you killed because of your maladaptive behavior.
IS THIS BEHAVIOR GETTING YOU WHERE YOU WANT TO GO?
A bandster once confessed, “I eat pretty good all week and then I allow myself a junk food day...a bad mistake on the weekend since that usually means a junk food weekend...once I start, it’s so hard to stop and of course weight gain is the result and I end up beating myself up. I'm never going to be where I want to be if I continue this behavior.”
I want to repeat that all-important last sentence: “I'm never going to be where I want to be if I continue this behavior.” That, my friends, is the take-home message of this article. Take it to heart, take it home, and take it out and study it often. Ask for help in identifying and dealing with your maladaptive eating behaviors. Take them seriously, but don’t build them into mountains right in the middle of your path to success. Sometimes the solution or treatment for a big maladaptive behavior can be a small piece of common sense. One of my favorites is: Don’t keep trigger foods in the house. If chocolate is your bête-noir (the black beast that’s the bane of your existence), you’re not going to be able to gorge yourself with it the next time you’re feeling weak if there is no chocolate in your house. Yes, I know you can hop in your car, ignore the posted speed limits, and pull up in front of the Chocoholic Market in a matter of minutes. That’s why we have to be vigilant, honest and aware.
And remember this, from page 299 of Bandwagon: It takes anywhere from 18 to 254 days of daily repetition to make a new behavior automatic….so, practice, practice, practice!
