Helen Bauzon

Hi Jean, Thanks once again.

Thanks so much. I'll keep them coming. food for thought.

Hi Amanda, To answer your question I'll refer you to the Lap Band Surgery page on my website. I have created a PDF file which is a cut and paste from my book which explains how the lap band works in very simple non-scientific language. Have a read then ask further questions. You will find the file at the bottom of the page. http://www.globalgastricbandsolutions.com.au/expert-advice/lap-band-surgery/

Hi Guys, Lets just keep it simple. You may like to try an exercise. Have a simple meal such as a dry biscuit and some low fat cheese or tinned tuna on top. Take 1 tsp portion, chew to a paste and wait one to two minutes and then take a sip of Water. If the water goes straight through, the upper part of 'funnel' concept is empty. It supports the research being conducted by CORE. Also keep in mind if someone has a pouch and oesophageal dilation, it's likely to take longer for the food to pass through. This is a whole other discussion. Once an individual loses their desired weight, removing the band or removing all saline from the system, will result in the hunger returning most likely. I see this in my practice when Fluid is removed short term for a variety of reasons, weight gain is common. In theory, each mouthful will take that 1-2 minutes to pass through the band all variables controlled. So whether it is the first or last mouthful it should be the same. I'm glad we are having a great conversation around this topic, because once the mechanics of the band is understood, from my experience more people will use the band correctly and minimize regurgitation and maximize their weight loss and well being. As a dietician specialising in the management of Lap Band patients I feel it is important to discuss the management holistically. Just like in my general practice, I explain what coeliac or diabetes is as a disease state prior to explaining the required dietary changes. Point taken, research articles will be included with the original post from here onwards. I feel very fortunate to be working so closely with the team at CBS and CORE to be made aware of the most recent research as it occurs. It is all about working together. Happy chewing.

To maximize the effect of the gastric band and limit your calorie intake and feel satisfied for longer, by eating more solid than liquid meals. Once on a full unrestricted diet, your goal is to work in partnership with the gastric band to limit your calorie intake and feel satisfied for longer. This will be easy for you to achieve by following the first key principle, chew your food do not drink them. The more solid in texture the food is on your plate that requires chewing to convert it into a paste, fewer calories will be consumed and it will help place pressure on the signal points with the gastric band to trick your brain and feel satisfied for longer after a smaller amount of food. Are you wondering what I mean by this? Let’s compare eating your fruit to drinking the juice. I glass of fruit juice would contain the calories of four whole oranges. The gastric band will allow you to drink these calories reasonably easily in a very short space of time. However to sit and plough through and chew up to 4 whole oranges, I know you would give up, it just takes too long to achieve. Liquid calories such as juice, soups, mashed vegetables and casseroles should be kept to a minimum for maximum weight loss results. The discussion needs to be taken one step further. To enable you to consume as many dry and solid textured meals as possible successfully with the gastric band, often you need to modify your food preparation slightly to make the meal more gastric band friendly. There are many foods we could use as an example, however lets use a few protein rich foods, such as a hardboiled egg, left over dry chicken and fish which can create havoc with the gastric band. Slightly better alternatives would include scrambled egg or a frittata, tinned chicken and tinned fish. These textures are still dry and solid but easier to eat pain free with the gastric band. This ever so slight modification to your meal preparation will enable you to eat more pain free. In summary, to maximize the effect of the gastric band and limit your calorie intake and feel satisfied for longer, by eating more solid than liquid meals.

Hi Guys, Lets remove nutrition from the discussion and focus on what texture of food that passes through the gastric band that will make you feel more satisfied. These foods include the more solid options such as a frittata. A frittata would be a simple meal of eggs, low fat milk blended with some carb free vegetables and cooked in a dish in the oven. No need to be high in calories, far from a quiche which I agree is a disaster in calories. It's amazing what impact different different terminology can have internationally. Elcee lets compare a meal such as a soup even of a thick consistency. The theory suggests that this texture would pass through the band easier compared to a salad and steamed fish which requires much more chewing to pass through the band. At the recent OSSANZ conference there was even a very small study showing participants felt fuller for longer on a solid Optifast bar compared to the optifast shakes. The nutritional value/content is exactly the same but the texture is different. The more solid the food is in the original form prior to consumption, the greater the satiety effect with the lap band. More studies are required with larger numbers at this stage to consolidate the finding. However I receive this feedback all the time from my clinics.

WOW, what great discussions, thanks so much guys. When ever evolving research challenges our belief system, it will always stir the pot. Let me address all of your concerns. (1) I have a Bachelor of Science degree and a Masters in Nutrition and Dietetics and an APD in Australia. I have worked with lap band patients since year 2000 and have counselled over 3000 individuals. I currently work with the Centre of Bariatric Surgery which is run by Professor Paul O'Brien, the founder of the lap band in Australia. I also work closely with Centre for Obesity Research and Education (CORE). I have been involved in research assessing the best nutritional make up of the diet and the ideal frequency of meals to lose weight with the lap band in association with CORE. As Cocoabean has linked above the new research regarding how the food passes through the lap band has been determined by Mr Paul Burton via CORE. I hope this helps show people I understand and practically apply the most recent research in my practice and recommendations. Thank you Jean for the clarification on why my Bio was not uploaded, much appreciated. More details can be seen at http://www.globalgastricbandsolutions.com.au/helen-bauzon/leading-bariatric-dietitian/ (2) The research surrounding the movement of the food bolus through the lap band was conducted on a texture of porridge with a well adjusted and well functioning lap band. So there would be no indication of a pouch or oesophageal dilatation. Hence the bolus of food would ideally be pushed through within the 1-2 minutes. If the area of above the lap band is empty completely of food, then there is no harm in taking a sip of Water for example. I have attached three articles by Dr Paul Burton which has some great graphics to view. I was unable to attach them here so you can view them at http://www.globalgastricbandsolutions.com.au/lap-band-diet-drinking-and-eating-with-your-food/ (3) If the food passes through that quickly if pain is experienced, then some possible explanations could be: A too big of a mouthful of food was consumed Not chewed adequately Did not wait long enough between swallows Possibly tried to eat a food that is generally difficult to consume with the lap band Had a previous blockage and swelling /irritation has resulted (4) These solid research findings by CORE have been implemented into a video presentation produced by Professor Paul O'Brien and is well circulated in Australia. I am aware that more footage is being prepared and once available I will inform everyone. (5) These recommendations are far from reckless and have research to support them. My passion and what I am known for is getting lap band patients to eat normal solid food pain free, but making them understand how the lap band really works. The lap band does not create a small stomach but rather a 'funnel' concept. The role of the band is to slow us down and make us feel more satisfied on a smaller portions of food by placing pressure on the receptor sites via the lap band itself and pressure from the food. (6) Please do not confuse this discussion with the impact of consuming liquid foods compared to solid foods and the effect on satiety. These are two different topics. (7) It is well respected that everyone with a lap band belongs to a particular weight loss surgery clinic with their own views and opinions. It is for this reason that I ended the article with two options for you to make a personal decision that would suit you best, highlighted below. Choose either option, or blend them both when it suits you as summarized below: 1. Wait enough time between mouthfuls before consuming a sip of your drink 2. Consume a glass of water before the meal, eat your meal then begin drinking again once you feel comfortable. I wish everyone luck with their own drinking and eating. Lets discuss further as required to clarify.

I just wrote an article, LEARN HOW TO EAT PAIN FREE, this will give you some ideas. After viewing this feel free to clarify anything.

Hi Guys, Thanks for your feedback guys. I'm not sure how it got to the thread, my apologies. I just submitted it as an article as with all my others as other health professionals not specifically as a thread. I'll have to look into it. Carole there are numerous reasons why one may feel pain on eating such as a food getting blocked or over filling the 'funnel' concept above the gastric band. These could include: too big of a mouthful, inadequate chewing swallowing too soon time of the day stress previous blockage to mention a few. Great news if you have not experienced discomfort on eating Carole. Keep up the great work.

Once on a full unrestricted diet, your goal is to work in partnership with the gastric band to limit your calorie intake and feel satisfied for longer. This will be easy for you to achieve by following the first key principle, chew your food do not drink them. The more solid in texture the food is on your plate that requires chewing to convert it into a paste, fewer calories will be consumed and it will help place pressure on the signal points with the gastric band to trick your brain and feel satisfied for longer after a smaller amount of food. Are you wondering what I mean by this? Let’s compare eating your fruit to drinking the juice. I glass of fruit juice would contain the calories of four whole oranges. The gastric band will allow you to drink these calories reasonably easily in a very short space of time. However to sit and plough through and chew up to 4 whole oranges, I know you would give up, it just takes too long to achieve. Liquid calories such as juice, soups, mashed vegetables and casseroles should be kept to a minimum for maximum weight loss results. The discussion needs to be taken one step further. To enable you to consume as many dry and solid textured meals as possible successfully with the gastric band, often you need to modify your food preparation slightly to make the meal more gastric band friendly. There are many foods we could use as an example, however lets use a few protein rich foods, such as a hardboiled egg, left over dry chicken and fish which can create havoc with the gastric band. Slightly better alternatives would include scrambled egg or a frittata, tinned chicken and tinned fish. These textures are still dry and solid but easier to eat pain free with the gastric band. This ever so slight modification to your meal preparation will enable you to eat more pain free. In summary, to maximize the effect of the gastric band and limit your calorie intake and feel satisfied for longer, by eating more solid than liquid meals.

There is no concern in flushing the food through the gastric band when the area above the band is empty. Recent research has provided a better understanding of the how the gastric band works, conducted by CORE in Melbourne. We now understand that food only remains in the area above the gastric band for approximately 1 minute, it is then pushed through the gastric band via the oesophageal pressure. This takes about 3 to 6 peristaltic motions. You can eat and drink at the same time; however it is essential you allow sufficient time between swallows to ensure the area above the gastric band is completely empty, before you consume a sip of your drink. However, be careful to not drink liquids with your meal to assist the movement of food through the gastric band, this is cheating. Focus on tasting and enjoying the flavours and textures which will enable your saliva to soften the food and make it easier to grind the food into a past prior to swallowing. Many people feed back to me that they often do not wait long enough between mouthfuls and take a sip too early and get into trouble. So you may wish to consider an alternative option to not drink and eat during your meal, but rather eat your meal and begin drinking again once you feel comfortable. Choose either option, or blend them both when it suits you as summarized below: 1. Wait enough time between mouthfuls before consuming a sip of your drink 2. Consume a glass of water before the meal, eat your meal then begin drinking again once you feel comfortable.

The less perfect you are, the more weight you will lose. Change your thinking and lose weight successfully with the Gastric Band, by proportioning 80% of your time follow eating well and being physically active and the remaining 20% let the rules relax. The Gastric Band does not stop emotional eating or grazing, you must do this yourself. Which categories do you relate to? 1. I experience good or bad days with my eating 2. Once when I start eating the wrong food, I can’t stop 3. I often crave food I shouldn’t be eating A great starting point is for me to help you stop feeling guilty about your food choices and stop you from starting yet another diet, as this mentality makes you crave and over eat the wrong foods. That is foods that slide through the Gastric Band very easily. The 7 steps below, illustrates what I describe as the dieting cycle. When this is broken, you can control your habit and stress eating with more ease. Dieting Cycle (1) You decide to start losing weight (2) You stop eating “Bad” Food (3) You crave “Bad” food (4) Eat some “Bad” food (5) Feel guilty and unhappy with self (6) Feel like broken diet & over eat (7) Will start again on …….. and the viscous cycle begins of trying to start again How To Break The Dieting Cycle. SOLUTION: Step (1) We need to stop the cravings, and the only way to do this is to STOP viewing food as being either “good” or “bad”. You may hear yourself making comments such as, “I can’t have that; it is bad” or “That is a bad food” for example. Instead, you need to describe the food for what it is. If there was a blind person who had also lost their sense of taste and smell and they asked you what chocolate tasted like, your description of: “oh, it is a bad food!” would leave them with no idea or understanding of the food. Rather, you should respond, “It is plain dairy milk chocolate in the shape of a small square, which has a rich chocolate taste”. Even having read this last phrase, have you felt your shoulders drop? Chocolate is just a food. Describe the food in a neutral manner. SOLUTION: Step (2) The second mistake we need to correct is to stop giving yourself permission to overeat. You must stop making the comment, “I will start again on …” This must be changed to, “I am not starting anything; I am not on a diet!” Then, you do not give yourself permission to continue eating the easy foods. Implementing both Solutions, Steps (1) and (2), takes practice and commitment. The more often you try to see the benefit of how it works, the faster you will obtain control of your weight with the Gastric Band. Slowly with practice you will gain more control confidence and you will begin to shine.

The less perfect you are, the more weight you will lose. Change your thinking and lose weight successfully with the Gastric Band, by proportioning 80% of your time follow eating well and being physically active and the remaining 20% let the rules relax. The Gastric Band does not stop emotional eating or grazing, you must do this yourself. Which categories do you relate to? 1. I experience good or bad days with my eating 2. Once when I start eating the wrong food, I can’t stop 3. I often crave food I shouldn’t be eating A great starting point is for me to help you stop feeling guilty about your food choices and stop you from starting yet another diet, as this mentality makes you crave and over eat the wrong foods. That is foods that slide through the Gastric Band very easily. The 7 steps below, illustrates what I describe as the dieting cycle. When this is broken, you can control your habit and stress eating with more ease. Dieting Cycle (1) You decide to start losing weight (2) You stop eating “Bad” Food (3) You crave “Bad” food (4) Eat some “Bad” food (5) Feel guilty and unhappy with self (6) Feel like broken diet & over eat (7) Will start again on …….. and the viscous cycle begins of trying to start again How To Break The Dieting Cycle. SOLUTION: Step (1) We need to stop the cravings, and the only way to do this is to STOP viewing food as being either “good” or “bad”. You may hear yourself making comments such as, “I can’t have that; it is bad” or “That is a bad food” for example. Instead, you need to describe the food for what it is. If there was a blind person who had also lost their sense of taste and smell and they asked you what chocolate tasted like, your description of: “oh, it is a bad food!” would leave them with no idea or understanding of the food. Rather, you should respond, “It is plain dairy milk chocolate in the shape of a small square, which has a rich chocolate taste”. Even having read this last phrase, have you felt your shoulders drop? Chocolate is just a food. Describe the food in a neutral manner. SOLUTION: Step (2) The second mistake we need to correct is to stop giving yourself permission to overeat. You must stop making the comment, “I will start again on …” This must be changed to, “I am not starting anything; I am not on a diet!” Then, you do not give yourself permission to continue eating the easy foods. Implementing both Solutions, Steps (1) and (2), takes practice and commitment. The more often you try to see the benefit of how it works, the faster you will obtain control of your weight with the Gastric Band. Slowly with practice you will gain more control confidence and you will begin to shine.

Hi Kellie, Let me clarify something first, before I answer your question. Making the assumption that there are no food blockages, no pouch (stretching of the stomach), the band is not over inflated, the food will remain in the small stomach for a very short time, 30 to 60 seconds, depending on the texture of the food consumed. Following this, there is no need to fast before an adjustment. For the 24hrs post an adjustment, ear soft liquid based foods, as there can be swelling and irritation post a fill. There are others who take an additional few days to receive the full effect of the adjustment. I hope this helps and good luck with your journey, it is very exciting. Kind regards Helen Bauzon Leading Bariatric Dietitian

Great comments thus far. The main one to add from here is that I would like you to eat the absolute minimum 800 calories, but my preference is 1000 to 1200. You need to eat to lose weight. Starving is not the way. I agree wound healing is the focus during this phase. Weight loss should also be monitored via your measurements and not only the scales, find a a shirt and a pair of pants that are too tight and wear them each week and enjoy the feeling of them getting too big, SLOWLY. Take care Helen Bauzon Specialist Bariatric Dietitian

An overly tight band is not good, however lets qualify this. If you find it does take some time in the morning like at 6am, (a glass of water over 5 minutes) this is not uncommon. However if you are struggling to consume fluids all day long, this is not correct and you need to go back to the clinic asap, to remove some fluid. I am sure that the doctors were just wanting to get you started by feeling restricted. Good luck Helen Bauzon Specialist Bariatirc Dietitian

Hi Guys, Fluid changes in the body, hence fluid restriction with the menstrual cycle explains why the band feels tighter at different times. In addition the band also feels tighter first thing in the morning. This is due to fluid changes. While asleep horizontal the fluid is distributed more evenly throughout the body, hence more around the band site. This makes the band feel tighter in the morning. As fluid drains south in your body during the day, less fluid around the banded area means it feels looser later in the day. I agree to get the nice restriction you need for dinner, often a banded individual can't cope with solid food in the morning until about 10am. Hope that helps. Helen Bauzon Specialist Bariatric Dietitian

The warning bells that I hear is that you have a PB 3 times a week bc you are going too fast. If you have another fill before you address this the PB's will only get worse and you will be more prone to eating the ice-cream, which is easy and soothing after a PB. I would recommend you manage things to reduce the PB to 1/fortnight the most then determine if you need or can manage another fill. If old habits are sneaking in, yes a little amount of Fluid will help take the edge off, but as others have commented (great to see), re-address your total food intake and exercise levels. Hope this helps Helen Bauzon Specialist Bariatric Dietitian

It sounds like you could improve your food choices. The best way to get re-focussed is to keep a food diary for 3 days, recording your intake as the day progress not at the end. Weight loss is slow and steady with the band. Avoid making the band too tight as this will likely increase your calorie intake further by not been able to eat "normal healthy food". Even being in the best head space at the moment, perhaps some counseling is an idea to help ward of the negative self talk sabotage your efforts. I am not keen on fad diets, bc if you have a history of dieting it will actually make you crave more when you return to normal eating and likely overindulge. Lastly what is happening with your exercise? A few things to think about Good luck Regards Helen Bauzon Specialist Bariatric Dietitian

At any time of the process, ensure you eat the correct texture to maximise the effect of the band, dry and solid food, everything else is too easy and will tend to cheat the band either high or low in calories, This early on in the program, you certainly need some fills. The extra gas is from surgery, and some people it can take a few weeks to completely settle. Try and avoid constipation, as this would make you even more bloated and uncomfortable. You need to consider a laxative in consultation with your dr and slowly increase the fibre back into your diet to normalise your motions. Good luck Specialist Bariatric Dietitian Helen Bauzon Welcome to globalgastricbandsolutions.com.au

This dietary phase is not easy, but consider it the last time you will ever be on a diet. If you follow the plan closely enough, your body will go into ketosis, within 3-4 days your hunger will be under control. If the diet is broken, your appetite does return. Clients of mine if still hungry after the initial 3 days I add more protein into their plan and they are pretty happy. Good luck. All for a good cause to shrink the liver done to make your surgery safer. Regards Specialist Bariatric Dietitian Helen Bauzon Welcome to globalgastricbandsolutions.com.au

The first time can be very scary, it is very important to learn from the experience and work out what caused it. Perhaps, too much food per mouthful, swallowed too quickly, did not chew properly, the food type, time of day, emotional state etc. Using a smaller eating utensil is crucial, take nibbles of bites into food and chew down to a mush and allow 30-60 seconds between mouthfuls. Good Luck Specialist Bariatric Dietitian Helen Bauzon Welcome to globalgastricbandsolutions.com.au

Dear Anita, Boy that is bad luck. I must say having seen thousands of people with the band, this level of complication I have not seen. The weight gain you have experienced may be due to the frustration and feeling let down by the whole process. I would hope that your Dr is giving some extra TLC. Keep at it and be extra patient until the process gets started. IN the mean time gain some control back in your life by focusing on what you can have control over. I think being active does wonders for your mind set, that includes fresh air. Good luck Bariatric Dietitian Helen Bauzon Welcome to globalgastricbandsolutions.com.au

Hi Jenwan, It is always best to discuss things with your doctor. My theory about weight loss with the band is simple: (1) Understand how the Lap Band works. (most people miss understand this) (2) Chew your food to a mush. It takes more than 20 chews. (3) Focus on the texture - solid and dry food and enjoy eating a little of everything We know what to eat to lose weight most times, but it is another thing getting through the Lap band and understanding why sometimes it fails to do so smoothly. It is lots of fun as you learn every day on your journey. Chat soon Helen Bauzon Bariatric Dietitian Welcome to globalgastricbandsolutions.com.au

Hi Guys, Jenwan you must be starving. Clear liquids for two weeks I don't believe this is necessary. The only reason you are on liquids post surgery is to allow the band to form scar tissue between itself and the stomach and to consolidate its position. I always recommend clear fluids for the day of the surgery, then free fluids up until week 2 and then transition slowly onto solid food. Regurgitation will only occur if you you take too much volume per mouthful, swallow too quickly and not chew your food properly. I also would recommend that you clarify with your doctor but I believe they are being far too strict. Good luck Bariatric Dietitian Helen Bauzon Welcome to globalgastricbandsolutions.com.au