Why avoid liquid calories?

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Why avoid Liquid Calories??

" Avoid liquid calories " is much more of a standard Band need than

many realize or choose to accept. It is not a question of one

opinion vs another opinion, but in my view is clear medical science,

basic nutrition physiology, and basic band knowledge, if we

understand how the band is designed to work.

The Band has 4 unique ways it helps us, and there is science behind

every one. Many docs don't explain how the band works or the

physiology behind it. They should, imo - How the size of the pouch

and it's normal stretching with solid foods is critical to satiety.

How chewing is essential to satisfaction . How solid food digestion

burns far more calories than liquid digestion - and this results in

more wight loss.

The Standards of Gastric Band Care and safety have been set for MANY

YEARS, IMO, by the highly-experienced European and Australian docs,

who have been banding 15 years or more and carefully follow longterm

results, as well as the longterm problems. Then, the experienced MX

docs followed them and have been banding about 8-10 yrs or so, and

advise the very same thing in most cases.

They ALL advise avoiding protein drinks. The Inamed patient Guide

(that I bet few of you have even been given by your US docs) was

written largely by Dr. Dixon and Dr. O'Brien, the 2 most

world-renowned band pioneers and researchers, from Monash University

in Australia. While some things are no longer accurate and the Guide

is under revision, they includes " avoid liquid calories " in it, very

clearly.

I have been in regular touch with Dr. Dixon for several years,

and he is one of the consultants on my upcoming book, as well as

several other world-renowned band surgeons. Almost all of the highly-

experienced Australian, European, and Mexican band surgeons strongly

advise only low-calorie fluids as a basic band need.

The US patients and docs sometimes seem very lax to me in accepting

these basic rules, and following them. And I'm afraid we are seeing

the results already in the many poor outcomes in the last couple of

US years of banding. There are several studies showing that US band

clients generally do much poorer than the European and Australian

band clients.

I believe a lot of this is because some of the US doc's inexperience

with good teaching and reviewing band needs. Many US docs don't give

any written info at all, let alone post-op wound care orders, LSD

information (there is NEVER a reason not to utilize an LSD, imo –

especially with clients over a 45 bmi) ,good nutrition advice, info

about good fills vs too much fill, or much more. While some are very

excellent, I'm afraid some docs are just not teaching well at all.

The fact is that the basic Inamed classes for new surgeons are only 2

days long, and nutrition is BARELY touched upon. It's up to the docs

to learn themselves, and this results in very little learning

sometimes, even though nutrition and food choices are an essential

thing for band success. Most are, understandably, 1000% busy with

surgery, fills, aftercare, and their own families.

Sadly, Few docs have anything more than the most basic nutrition

classes from med school. Surgeons never thought they would be

involved in ANY longterm care of patients. Most saw a patient for

surgery, possibly once for followup, and then moved on to a new

patient. They are just not trained for longterm care, and especially

re nutrition, and even more especially about very specialized BAND

nutrition. Some, still, become quite good with years of experience

and willingness to learn from others.

US Newly released statistics show a DOUBLING of serious band problems

like slips and erosions. They are even higher than the very first

stats from the first few years of US banding, when ALL the docs were

brand new and inexperienced. IMO, I'm afraid this reflects the many,

many very inexperienced docs who don't even know basic band rules.

Thern, very new info as of Jun/July 2008 is out about the nutritional

deficiencies even BAND patients are showing. While We SHOULD be

eating enough and well so we can avoid deficiencies, many simply are

not – staying way too tight for either safety or good nutrition.

I hear almost EVERY week from docs AND nutritionists who have seen

the band guide that I have sent people here. They ask " Where did you

get this info? " And then they are very embarrassed when I send them

the links for the Inamed patient guide, current research, current

stats, the published band books already out, and more. Some have

never seen or heard of any of this information - VERY troubling, for

sure. Most bariatric nutritionists know only BYPASS needs, and many

have not even seen the basic nutrition info from Inamed, including

the " no liquid calorie " rule. Others simply hand out the Inamed

Patient Guide, without knowing that there is much new info since this

first came out 7 yrs ago. It still, for inatnce, advises coirnflakes

and bread with every meal, and " only 3 small meals a day. " Very sad,

imo, and a great disservice to Bandsters.

If you're interested in the " liquid calorie question " ,

Read the literature ! Read the published studies and articles ! Read

the links to Inamed info that clearly state to avoid liquid

calories! Learn the physiology of how the band is meant to work. Take

some higher-level nutrition classes. Read the published band books

and Guides, particularly Jessie Ahroni's Band book, which is

considered the Bible of band care :

http://www.iuniverse.com/bookstore/book_detail.asp? & isbn=0-595-31114-8

" No liquid calories " , stated again and again.

Read Dr Ariel Ortiz's Band Book, (Lap Band for LIFE) in which he

states (and I quote directly):

" You can try it the experienced surgeon's way or not. Sooner or

later, you will end up following the guidelines that have PASSED THE

TEST OF TIME. We start out (in the Guidelines for nutrition and

success chapter of the book) with the TEN RULES OF SUCCESS, developed

by Dr O'Brien of Melbourne, Australia, and Dr Rudolph Weiner of

furt, Germany - two of the leading Lap-Band surgeon in the

world. "

I'd suggest listening to Dr Ortiz, and to the other longterm Mexican

band surgeons. He has been banding close to 10 yrs by now, and has a

huge number of successful band clients, as does Dr Kuri, my own doc,

with even more experience. Dr Kuri also advises " No liquid

calories. "

Rule # 9 in Dr Ortiz's book (taken directly from the Inamed guide)

is " Drink ONLY low-calorie fluids. " Dr Ortiz elaborates, " Drinking

water, tea, coffee without milk or sugar, and any other NON-CALORIC

fluids is acceptable. Crystal light is a satisfying beverage for

many. Carbonated fluids are not encouraged. "

This all seems VERY clear to me. Ignore all the advise of those with

many years of experience if you wish, both MD's , bandsters,

nutritionists, and others, but I sure would not advise it.

My gentle and heart-felt suggestion is to realize that what we have

tried in the past - going off on our own - has not worked (or we

would not all be here needing banding!). Why not learn from the

highly-experienced people and do what they do and advise?? Very

truthfully, about 99% of the people I know who got to a good goal

weight SAFELY (thousands of people, by now) , are those who listened

and followed the well-known rules.

There are also a great many purely physiological reasons why liquid

calories are a very poor idea - just do some homework in the areas of

nutrition and physiology - or ask, if you're still unsure. Why

ignore clear scientific fact? THis is not opinion, but physiology.

Dr Curry here on OH does NOT advise regular use of protein drinks. He

states only that for those too tight in the morning for a real

breakfast, protein drinks are " better than nothing " . This is a last

resort, and in my experience, most people can easily stop being too

tight in the morning.

Here are some recent links from the literature about liquid calories

and obesity:

http://www.sciencedaily.com/releases/2007/11/071119170150.htm

http://www.burnthefatblog.com/archives/2008/04/how_liquid_calories_may

_be_mak.php

http://www.washingtonpost.com/ac2/wp-dyn/A30903-2004Dec28?

language=printer

http://www.med.umich.edu/prmc/radio/2006/BeverageswMASTER.htm

There are a few times when protein drinks are just fine – on a pre-op

LSD (although a good LSD can also be 100% SOLID protein, which is

much more satisfying and easy to follow), in the first few weeks

after surgery before we are back on soft foods, and for the brief

times when we need a fluid rest after a band problem.

A few are too tight in the morning for a decent breakfast - but why

not correct the problem so you can eat well?? It's easy to do.

Regular use of protein drinks easily sabotages band loss, and this

has been demonstrated repeatedly. But it's always up to you, of

course - to do as well as possible, or to make excuses and take the

easy way out and not correct problems, and then come back crying that

you are not doing as well as you expected.

Further, if we use protein drinks to meet protein needs, this is very

different than meeting IRON needs. Protein drinks have little if any

iron. We need the solid foods like red meat, turkey (much better than

chicken) pork, and shellfish to meet iron needs. Protein drinks have

little if any fiber. If we use a protein drink instead of breakfast,

for instance, it's nearly impossible to meet daily fiber needs

without an expensive supplement. And supplements for fiber do not

promote weight loss in the least. Fiber FOODS do. And the next time

you see your dentist, ask him/her what having liquid meals as opposed

to solid meals that require chewing, does to jaw, oral, and teeth

health.

Some here surely have lost well, using regular protein drinks. This

may be fine IF nutrition needs are met, and IF they are satisfied

between meals and not snacking. But for those UN-happy with their

progress, stopping the liquid calories would be my first suggestion.

I only want you all to do great! And this means not simply losing ok

in the fist 6-12 months, which is pretty easy, but losing well

longterm, learning good eating habits to last a lifetime, and then

being able to maintain lost weight. THAT is success - not simply

short term loss in the months or year. Losing gets harder as we go

on, because we need fewer and fewer calories, and we have to refine

and perfect our intake and eating more ad more.

Our success truly IS up to us, and the choices we make.

This is what I believe about liquid calories.

Sandy R, BSN, MN

at goal x 4.5 yrs

Moonshadow.Sandy@...