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The Ten Commandments of Life After Bariatric Surgery

Commandment 1: Take it slow. 

Do not gulp, guzzle or rush through a meal.  Rapid eating is the same as not chewing.

Commandment 2:  Chew thoroughly (20 times)

Every bite of solid food needs to be chewed thoroughly.  The obvious reason is to reduce the size of the food bolus about to be swallowed.  Larger pieces are more likely to get "hung up" in the pouch and cause distension and pain.  Each bite should be chewed 20 times.  Yes, this means that initially you will need to consciously count (in your head, please) every chew.  As time progresses, the need to count will be replaced by the innate feeling that this piece of food is "ready to go down without a fight".

Commandment 3: Space your bites.

Literally, put you're fork or spoon down in-between bites.  Do not pick up your utensil for 45 seconds.  By doing this you will be taking more time to chew and more time to acknowledge your sense of feeling full.

Commandment 4: Wait to drink.

Do not have a beverage at least 20 minutes before any scheduled meal and wait at least 20-30 minutes after you finish eating.  Liquids will quickly soften the ingested food allowing it to be washed through the pouch.  Your pouch will empty sooner leaving you feeling hungry.

Commandment 5:  Eat your protein first.

The most important constituent of food for overall health is protein.  Protein can be thought of as the scaffolding of our bodies.  From our nails to hair to muscles we are comprised of protein.  Eat your protein first at every meal.  That is, have your chicken, fish, eggs and seafood before taking your first bite of mashed potatoes.  If you're going to fill up quickly then make sure this is from protein.

Commandment 6:  Avoid liquid calories.

Not even the finest sieve (colander) can prevent liquids from passing through.  The same holds true for the band.  Beverages that are high in sugar (apple juice, orange juice, grapefruit juice) will quickly pass through your pouch with little to no sense of restriction.  Patients can easily obtain 1000-1500 calories each day from nutritiously empty, high caloric beverages.  High sugar liquids can cause symptoms of nausea, vomiting, diarrhea, sweating, heart palpitations, bloating and gas, all components of the syndrome referred to as "dumping".

Commandment 7:  Have three meals each day.

Plan each day to have breakfast, lunch and dinner.  If you work at a place where you are limited to poor food choices then pack your meals.  Do not substitute meals with frequent snacks.  Train your body and your mind to have each meal.  If you find that at a certain meal you just don't want to eat, that's okay.  Have a smaller size meal, but do not turn around and have multiple snacks awaiting your next meal.

Commandment 8:  Avoid snacking between meals.

The need to snack comes from failing to eat scheduled and balanced meals.  As you become more used to having three meals each day your need for a snack will begin to dissipate.  Instead of eating, drink plenty of water or other non-caloric beverage in between meals.

Commandment 9: Exercise for 30 minutes three times each week.

The importance of exercise cannot be overstated.  Aside from the impact it will have on weight  loss, exercise will promote better food choices, improve confidence and help reduce cravings for high sugar, nutritiously devoid foods.

Commandment 10: Listen to your pouch.

When you are full, stop eating.  When you begin to feel full, stop eating.  When you begin to become uncomfortable you have failed to listen to the signals your body is sending you.  For some patients the signals may be relatively subtle, maybe some gurgling or a small belch.  Take these as cues to stop eating.  Wait for 10 minutes and see if you are still hungry.

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