What About Protein After A Gastric Band?

The Gastric Band & Protein

When you have had a gastric band placed there is no need to increase your protein intake however the recommended daily amounts still apply. This is 55g per day for an adult woman but the requirements are higher for those who engage in a lot of exercise. Often band patients neglect to eat protein as it requires more chewing and is more difficult to eat.

Once you resume eating normally after having your gastric band it is a good idea to eat your source of protein first. It may be more challenging to eat and will require more chewing than other food types. It is important that you really do chew your food well before swallowing, as this helps the digestive process. As you chew saliva is produced and saliva contains digestive enzymes that start to break down the food into smaller components that the body can absorb and use.

 

You do not need to drink a protein shake routinely just because you have a gastric band. These may be useful if you are on the go a lot and find it difficult to eat healthily. However a word of caution, some contain large amounts of sugar and these should be avoided. It is far better to eat real protein foods, focussing on the low fat plant proteins with some lean cuts of meat and fish. Avoid creamy or buttery sauces while trying to lose weight post-surgery as they are very high in calories.

 

The PVC Rule!

Eat the PROTEIN on your plate first.

Next eat the VITAMINS and minerals found in your vegetables or salad.

Lastly eat the CARBOHYDRATE content of your meal.

Gastric band diet plate

Why Protein Is Important

Protein is essential for the growth and repair of all the body’s cells, we cannot survive without it. It’s a good idea to eat a little bit of protein with every meal every day. Protein helps us to feel full for longer and stabilises blood sugars. Keeping blood sugars stable throughout the day is key to weight control, because if blood sugars are fluctuating all over the place we are more likely to crave sugary high calorie foods and therefore make poor food choices.

More About Protein

There are two types of protein- complete and incomplete. This classification refers to how many amino acids the protein contains. Amino acids are the building blocks of life. To keep it simple: animal products like milk, eggs, cheese, meat and fish are all complete proteins. They contain all eight essential amino acids. The only exception to this rule is food made from soy protein (such as tofu), this is also a complete protein.

Plant foods like grains (wheat, oats, barley and rye), lentils, beans, pulses, nuts and seeds are called incomplete proteins because on their own they do not contain all the essential amino acids. However, in combination they do. Therefore if you are vegetarian, or eating very little meat or fish, it is important to understand how to combine your proteins to make sure you are getting all the amino acids your body needs.

 

For example:  peanut butter on toast =a complete protein; lentils and rice = a complete protein.

Protein

Animal proteins like meat and dairy products are much higher in saturated fat than plant based proteins. These should be eaten in small amounts and not every day Also think about portion size, a portion of cheese need be no bigger than a small box of matches. A portion of meat needs to be no bigger than a pack of playing cards. Butter is fine to eat but should be spread thinly.

To summarise after having a gastric band be aware of your protein intake and stick to the Eight Golden Rules!

 

Getting Active & Fit After Gastric Banding

Top Tips For Getting Fit After A Gastric Band

Getting Started 

Before you embark on any exercise programme ensure that your surgeon or GP is happy for you to start exercising.

GETTING fIT

Walking is the best way to get started and completely free of charge! If your joints can’t handle it be brave and try the swimming pool, or an exercise bike as this will take the pressure off the joints until you have lost more weight.

Plan your exercise programme because unless it fits in with your life you won’t do it. The best is little and often as this is as beneficial as one long exercise session. Try and find a friend to exercise with you, this will help keep you motivated.

Up Your General Activity 

You can burn calories and keep reasonably fit without formally exercising and without even noticing which is great if you are not an exercise enthusiast!

 

Top Exercise Tips

Stairs

  • Get out of the lift 1 floor early, avoid escalators and use the stairs.
  • Park a small distance away from your destination and walk rather than try to find a closer parking space.
  • If you are travelling by bus, get off a stop earlier and walk the rest.
  • While watching TV challenge yourself to get moving during the commercial break.
  • Housework burns a lot of energy so count this as a workout and get scrubbing and spring cleaning.
  • Gardening is great exercise plus you benefit from being outside in the fresh air.
  • Avoid energy saving devices as you want to be using energy, not saving it!
  • Climbing the stairs is a great workout and a fantastic energy burner. If you take the challenge to try every second step your legs and bottom will benefit from additional toning.
  • Try and avoid prolonged periods of sitting, take regular breaks to walk around and stretch, this will also help your back and shoulders.

Gardening

 

Fun Toning – Wherever and whenever you can!

 

  • Brushing Teeth Squats – Squat as you brush. Lower your bottom in line with your knees and hold on to the sink if needed. Repeat 10 – 20 repetitions.
  • Worktop Press Ups – Stand with your feet approximately 1 metre away from the top and place your hands on the counter top. Bend your elbows to lower your chest towards the top of the counter then push away to straighten the elbows.
  • Washing Up Balance or Shaving Balance – Stand on one foot and hold as long as possible. Switch foot and repeat- this is great for legs, abdominal and lower back strengthening.

 

Gradually make exercise part of your regular routine, when you start to feel and see the difference it will motivate and inspire you to continue plus you will reap the rewards of the health benefits and enhance weight loss. Try and work out outside perhaps join a community group and make it a social event!

People exercising

 

Mindful Eating With A Gastric Band

 

What is hunger?

So now that you have a gastric band let’s talk about hunger:

Your Hunger

The first thing is to learn to recognise both physical and emotional hunger. You are probably wondering how do you recognise physical hunger and differentiate between the two? When you are physically hungry the hunger builds up gradually and when you eat this leads to a feeling of satisfaction. In contrast emotional eating builds suddenly and once you eat it leads to feelings of guilt and shame. Emotional hunger cannot be satisfied and despite eating the emotional hunger persists as food is not designed to satisfy emotions.

 

Healthy Mind

In order to develop a better understanding of emotional hunger you need to identify what the triggers are that lead you to eating:

 

  • How you feel, where you are and exposure to certain foods may trigger an urge for food
  • Triggers that start a food & eating behaviour fall into two groups:
  • Food ~ Usually high fat & sugar processed foods
  • Feelings ~ Happy, sad, angry, grieving
  • Situations ~ Watching TV, trip to the cinema, long journeys & even after exercise.

Triggers start a series of events much like a line of dominos falling. Learn to recognise, understand & manage what triggers your eating behaviour. This takes practice!

 

Identify your “trigger” feelings e.g. anger, hurt, exhaustion, sadness, happiness.

Remember….

 

  • These are simply emotions
  • They cannot “make” you do anything
  • These feelings have no power
  • YOU have control over your actions

Recognise the emotion for what it is

Recognise some types of food you choose may lead to overeating

Actively decide not to be fearful of food & eating

 

  • Change a situation or routine to manage it
  • Plan ahead and ask yourself, “What could I do instead?”
  • Recognise that food will never permanently satisfy emotion
  • Once you have identified the emotions that trigger your desire to eat, you can find other ways to comfort, nurture, calm & distract yourself without turning to food and eating

Thinking of Food 2

CHANGE

 

  • Having a gastric band means that you will need to accept and work with change of different types:
  • Physical Change, Emotional Change, Relationship Change, Social Change & Behavioural Change

 

STEP ONE – ACCEPTANCE

 

  • Accept that change is not just about reduced size
  • Accepting behavioural change includes food & eating behaviours
  • Accept that change is hard work & ongoing

 

CHANGE

 

STEP TWO – RECOGNISE

 

  • Change may be uncomfortable
  • For many of us it is more comfortable to remain as we are, exerting no effort.
  • Changing in size and shape is not always comfortable and may trigger difficult memories

 

At the start of every day, make yourself some promises, set yourself some goals:

 

  • I am going to change because………….
  • I am WORTH it because…………………
  • I WILL change to achieve………………
  • TODAY I am going to…………………….
  • TODAY when I achieve……… I will praise myself
  • I ACCEPT I may lapse & that is ok – I will use it as an opportunity to learn more about myself

 

Remember the Eight Golden Rules to be successful with your gastric band and along with being more mindful and developing coping strategies for when the emotional hunger creeps in you be in control of your mind, band and your life!

 

  • Eat three or less meals per day.
  • Do not eat between meals.
  • Eat slowly and stop when no longer hungry.
  • Focus on quality, nutritious food.
  • Avoid calorie containing liquids.
  • Do some form of activity for 30 minutes a day.
  • Stay active throughout the day.
  • Stay in contact with your clinical team.

 

 

Gastric Banding Lowers Mortality & Reduces CV Risk Long Term

Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and non-diabetic obese patients undergoing gastric banding: a controlled study

Bariatric surgery improves quality of life in morbid obesity, prevents development of medical complications of obesity, reduces the frequency of co-morbidities, improves cardiovascular (CV) risk profile and is cost-effective in the management of obesity. A few papers, analysed in a meta-analysis by the group, have described reduced long-term mortality after bariatric surgery in comparison with non-surgery controls.

Even though worldwide trends in choice of surgical techniques are changing the above mortality studies were performed using gastric banding (LAGB), vertical banded gastroplasty, and gastric bypass (RYGB). More recent studies have substantiated this finding showing a decreased number of CV events. Studies have later shown an improved life expectancy over controls also for surgery patients suffering from CV diseases and in cohorts predominantly made of male patients.

In spite of the recommendations by the International Diabetes Federation: Bariatric surgery is an appropriate treatment for people with type 2 diabetes and severe obesity (BMI ≥ 35 kg/m2) no study compared death rates in diabetic and non-diabetic patients. A few studies also showed that bariatric surgery prevents major complications of obesity, namely diabetes mellitus and hypertension, but no study compared new incident diseases in diabetic and non-diabetic patients.

The first aim of this retrospective study was to analyse long-term mortality in diabetic and non-diabetic obese patients undergoing laparoscopic gastric banding in comparison with standard medical treatment, in a group of Institutions using the gastric band with a common protocol.

This is the longest follow-up study performed to investigate mortality in LAGB as opposed to medical treatment. The study found that after a follow-up period of up to 17 years, diabetic and non-diabetic patients undergoing LAGB died less frequently than control patients, and experienced a lower number of new diseases, in particular CV diseases and diabetes.

Death counts were similarly lower, for both diabetic and non-diabetic patients, with surgery. In addition, this is the longest follow-up study performed so far, with no patient lost to follow up; the low number of patients observed after a mean period of almost 14 years simply depends on the late beginning of treatment, surgical or medical, and a longer follow-up period will make these numbers greater. Since this is an ongoing study, a further 5 years follow-up study will answer many of the as yet unresolved questions.

Benefits of bariatric surgery are probably more than simply related to improved metabolic control; improvement of metabolic control with resolution of diabetes can last several years but diabetes can re-appear after resolution, while other effects (lipid metabolism, kidney function, systolic and diastolic blood pressure) can be maintained for longer periods, being instrumental in the better overall prognosis. A few, mostly uncontrolled, studies have shown additional effects: improved endothelial function, decrease of intima-media-thickness (IMT), reduction of insulin resistance, decrease in vascular and general inflammation, increase of HDL cholesterol, decreased sympathetic activity, decreased left ventricular hypertrophy; these effects have recently been reviewed, and might explain the effects of bariatric surgery on cardiovascular disease.

The study found that a small weight loss persists years after LAGB, and might be one of the reasons for decreased mortality, together with reduced incidence of diabetes and CVD; also, the number of patients with arterial hypertension (with or without organ damage, was different at the end, and can be of clinical relevance.

Finally, we should remember that at present data about reduced long-term mortality after bariatric surgery are available only for LAGB and RYGB, while there is no information available for sleeve gastrectomy, biliopancreatic diversion, and biliointestinal bypass, three types of very effective surgery.

In conclusion, this data shows that gastric banding is associated with lower mortality up to 17 years in diabetic and non-diabetic obese patients, and with fewer new cases of diabetes and of CV disease.

A new examination is planned for September 2017. If the above assumptions are correct, we expect an even greater preventive effect of LAGB in diabetic and non-diabetic patients with morbid obesity. The fact that benefits were similar in diabetic and non-diabetic patients is of clinical relevance; diabetologists should inform their patients of the potential benefits of bariatric surgery, not only the possible remission of diabetes, but also the protective role against excess mortality.

The LAGB10 working group includes people from Ospedale San Paolo (Annamaria Veronelli MD, Barbara Zecchini BSc, Ahmed Zakaria PhD, Francesca Frigè BSc, Luca Rossetti MD, Alberto Benetti MD, Maurizio Cristina MD, Ermanno Mantegazza BSc, Alberto Morabito PhD, Antonio E. Pontiroli MD), from IRCCS Policlinico (Enrico Mozzi MD), Ospedale San Raffaele (Alessandro Saibene MD, Michele Paganelli MD, Paola Vedani MD), from Istituto Clinico Sant Ambrogio (Giancarlo Micheletto, MD), from Istituto Multimedica (Valerio Ceriani) and from the Health Districts (Maria Grazia Angeletti MD, Mariangela Autelitano MD, Luca Cavalieri d’Oro MD, Piergiorgio Berni MD, Antonio Giampiero Russo MD).

 

Reference: Cardiovascular Diabetology 2016 15:39 DOI: 10.1186/s12933-016-0347-z

Authors: Antonio E Pontiroli, Ahmed S. Zakaria, Ermanno Mantegazza, Alberto Morabito, Alessandro Saibene, Enrico Mozzi & Giancarlo Micheletto