Thursday, April 9, 2009

Eating and pregnancy after surgery

A couple of you asked some good questions about how things like eating and being pregnant work after having lap-band surgery. Obviously, having not done it yet, I can't speak from experience, but I can tell you that I asked the surgeon and nutritionist all of those questions as well and they gave me some very useful responses.

As far as the eating goes, with the lap-band surgery you sort of pare down what you eat gradually. So once I've recovered from the surgery I'll probably be eating about a cup and a half of food at every meal. As they start to fill the band and tighten the restriction, that amount will be reduced until it ultimately settles at about 3/4 to 1 cup of food at every meal.

And by the way, since this was a question I had about the fill--the way it works is that there's a little port that's connected to the pouches on your band. The port is attached to your abdominal wall during surgery. After the surgery, the doctor gives you your fills by using a small needle to inject non-acidic saline fluid into the pouches on the band through the port. So basically, it's a small shot in your stomach.

The recommended diet is three meals a day, plus a protein-heavy snack (like cottage cheese). And the beauty of the surgery is that that's all you need in order not to feel hungry. You are supposed to take at least 20 minutes to consume each of your meals (unless you start feeling full sooner, in which case you should stop eating immediately). This means that you thoroughly chew all of your food before swallowing it, and make sure to put your fork down between bites. Eating slowly gives your stomach time to send the brain the signal that it's full, so that you won't want to eat too much. Because the pouch above the band is in the part of the stomach that senses fullness, it doesn't matter that the part of the stomach below the band is empty--your brain will still think you're full, even though you're only consuming something like 1,000 to 1,200 calories every day.

So, I won't have to deal with cravings and feeling hungry at other times. The food that I eat will be enough to prevent me from feeling hungry until my next meal. That's the difference between the surgery and a diet. Whereas now, it takes a lot of calories to maintain my weight, and my body thinks that it's doing me a favor by trying to maintain or even increase my weight (I'll be the last one standing in a famine!), after the surgery I'll feel full after much less, and for longer. This is what causes the weight loss without the unsustainability of a regular diet that makes you feel hungry all the time.

And, while you are getting a lot fewer calories, once you get down to a healthy weight, those calories are all you need to maintain your weight. You aren't starving yourself. You're just eating a lot less than what your body used to think that it needed to eat.

This doesn't mean that I won't have to deal with "head hunger," or emotional hunger. The social worker gave me a handout on that, and I think it's the kind of thing that everyone experiences to a certain degree. An example would be if you weren't feeling hungry, and then you saw a photo of a cupcake and suddenly you were like, I WANT A CUPCAKE. That's emotional hunger, as opposed to physical hunger. That won't go away. But since I'll have such a small stomach pouch, I won't be capable of acting on any head hunger that I might experience. And I've never had huge problems with emotional hunger to begin with.

Also, you can't drink during meals or for half an hour after. This is to prevent you from washing all your food down your stomach too quickly, which would mean that you'd feel hungry again too soon. And you can't gulp big glasses of water, ever, because it'll just come back up--there's no room in the pouch for that much water. (Plus, you can't use straws because they get air into your pouch.) So, my plan to stay hydrated is to get a 64-ounce water bottle, fill it at the beginning of the day, and slowly sip it all day, making sure that it's empty by the time I go to bed.

As far as eating during pregnancy goes, I'm not sure what the hunger and the cravings will be like, but all the doctors I've talked to agree that you do not need to really eat much more than normal during pregnancy, whether or not you've had the surgery. When I do get pregnant, I'll meet with the surgeon and dietitian and make sure I have an OB/GYN who is familiar with post-surgery patients, and decide on what's right for me. But the dietitian said that most likely I can just add in one extra snack a day and I'll be fine. The good thing is that because I'll already be eating a protein-heavy diet rich in nutrients, I'll be ahead of the curve in terms of eating good-quality foods that provide nourishment to the fetus.

I don't know if I'll experience massive hunger during pregnancy and breastfeeding, or if the pouch will override that. If I do need to eat more calories (like if I were carrying twins or something), I could have the band's fill temporarily removed or reduced, which would mean my stomach wouldn't be so restricted and I could eat more. That's one of the nice things about the lap-band as opposed to the bypass.

But honestly, it sounds like I probably will not need to dramatically increase my food intake in order to nourish the fetus. As long as I'm getting enough vitamins and nutrients, it should be fine. The research that I've done online corroborates this--see here for an explanation of how it's not about how many calories you eat while pregnant, but about the quality of the food. It looks like most pregnant women need to add only about 300 calories a day, and only during the last six months of pregnancy.

If anything, I'll probably need to add less than that. Since I will never be tiny, I will have enough fat and calories already stored that I won't need to gain as much weight during pregnancy as most people. While a lot of pregnant women seem to aim to gain 25-30 pounds during pregnancy (and many come in much higher than that, I know), my goal will probably be more like 15 pounds.

This is a bridge that I will have to cross when I come to it, and it will very much depend on my personal situation. The nice thing is that there's a whole team of nutritionists, social workers, and the surgeon himself, plus my endocrinologist and future OB/GYN, to help me deal with any issues that might come up and help me make the decisions that best fit my individual situation.

So, there you go. Eating habits and pregnancy after lap-band surgery explained, at least to the best of my current knowledge. As I go through this experience myself, I'm sure I will have a lot more to say about how it works and what it's like. Really, it won't be that different from my current healthy living efforts--there will just be an extra aspect to it, an amazing one that means that everything I do will be much more effective. But there will still be the efforts to eat right, get to the gym, and generally struggle with my feelings about my weight. But knowing that it will really pay off this time, long term? That makes all the difference.


  1. I think we're all different. So, there will be lots of bridges for you to figure out how to cross. But, I appreciate you've really done your homework. You're ready emotionally for this surgery and you're armed with plenty of information. So, do you have the surgery before or after you move?

  2. This is all SO INTERESTING. Can't wait to see how it all plays out. I do feel, in general, that most people worry too much about eating and pregnancy. Those babies are wiley suckers and tend to get theirs, no matter what :-)

  3. It's true, you don't technically need much more calories during pregnancy. In the first trimester especially, it's all about small quantities of bland food.

    But then in the 2nd trimester, there are days where I am RAVENOUS. MUST. EAT. LOTS. Same with water. Sometimes I feel like I could drink a gallon in a sitting. Also when I get hungry and how much are not as easily regulated. So while calorie-wise, there is probably no issue, it's the control over rate of delivery that gets under attack a bit.

    Then in the 3rd trimester, I'd be interested to know if there's any potential trauma to the lap band/stomach from getting squeezed upwards as your uterus expands.

    Would it be useful to talk to an OB just to get a different perspective? I don't know. Sounds like the band is adjustable at any rate, just in case.

  4. Ooh. Let me qualify that above statement by saying that's MY experience, not everyone's. So those are the things I thought of from my perspective, not that they would apply to you.

  5. It's always funny to me when people remind me that I'm 'eating for two' because you're right, it's only about 300 extra calories/day that are needed.

    I always thought it would be absurd if I gained any weight during pregnancy because I figured I already had enough to go around. There's freedom in knowing that it's okay that I DO gain some though. Because right now, me and cookies.....mmmmm..... :)

  6. I was totally interested in every single sentence. This is so neat.

  7. Work's been crazy so I missed the last post. Good luck with everything! I know that with gastric bypass, I have to be EXTRA careful of mu nutrient and vitamin intake now and especialyl during pregnancy. but, with a lap band, that's not a big issue.
    congratulations ont he big step you took towards the bginning of a whole new life. I cannot tell you what it felt like to be able to fit into a size 10 jeans (even a size 8 but that created a very ugly look above the waistband) when I was wearing a size 24 right before surgery.

  8. You write about this with such clarity. It is so interesting. And it sounds very, very SANE.

    Oh, I am getting very excited for you. This is going to be such an wonderful journey -- and an interesting one, too.


  9. this is all so fascinating. i think the thing that would be the ABSOLUTE hardest for me would be the eating slowly part. how sad is that? i'm like "a cup of food? meh. sure. whatever. i'm sure i'll be starving. but you want me to eat it SLOWLY?? are you NUTS?"

    this comes from having a Very Hungry Father who would eat all the 2nds and 3rds of everything on the table if you weren't fast enough to grab your servings first.

  10. The water bottle's a great idea, for anybody actually.

    My SiL was overweight when she got pregnant, and soon after she took a nutrition class because she's going to be a nurse. She ended up LOSING 25 lbs. her first several months of pregnancy. The attitude that, "I'm pregnant! I can eat whatever!" is so dangerous. My friends and I have a joke that pregnancy is the leading cause of obesity in American women. Which really isn't that funny because it's probably true.

  11. 1200kcals sounds like nothing, especially if that's all you can eat to maintain later (I mean if you do some sports and don't sit around all day your body already needs more than that)! I am not sure I understand how that works. (Losing weight at 1200kcals, yeah, but maintaining at the same amount? Does the lapband make your body extra efficient at absorbing what it needs?) Is this lapband a permanent thing (I know it can be removed but do they usually do that, or do they just do it if there is a problem)?
    Anyway, I hope this works for you, and that you will not have any negative side effects! I have been overweight for several years now, and while it is not enough to get surgery on it, I know how it can get you down (even though I never have problems with chairs etc. so I can imagine that it must be worse if you do).

  12. This is all really interesting--thanks for sharing your process with us! I had two questions:

    a) what happens when you get to your goal weight? It seems like 1000-1200 calories wouldn't be enough to maintain it. Do they gradually remove/relax the band or something?

    b) how will the limitations on water affect your ability to exercise (I know I couldn't run far or do anything strenuous if I didn't take some big gulps of water during breaks) or breastfeed (which I've heard makes people incredibly thirsty)?

  13. This is so interesting. I'm so glad that you feel comfortable enough to discuss it, because man am I learning.

  14. The only thing I'll say about pregnancy is that while it's nice to think about how you'll WANT to eat, your body does change, and a healthy diet is sometimes totally unmanageable. Pregnancy is known for its "cravings", but what it really should be known for is AVERSIONS. Or rather, whatever will stay down or sounds remotely appealing.

    As you said, you'll have to cross that bridge when you come to it. But you'll be fine.

    Again, I know someone mentioned this before, but you should talk to Amanda at Mandajuice. Not only did she have the surgery, but she got pregnant pretty much immediately after she had it. She's an awesome resource on so many things, and I know she'd love to talk about this.

  15. I am always so impressed at the amount of research you put into your life.

  16. Sounds like you made a well-informed choice. Can't wait to hear about your journey. I'm excited for you!

  17. OMG, the part about liquids freaks me out! I drink a LOT during the day. What if you're just...THIRSTY? Or what about if you have a really strenuous workout and want to drink a lot afterwards?