Restriction Riddles
RESTRICTION RIDDLES
Restriction is the holy grail of bandsters, but even when you find it, it may not cooperate with you all day every day. Its fickle nature may allow you to eat one food on Tuesday but not on Wednesday. It may not show up until 2 weeks after a fill, or it may disappear 2 weeks after a fill. You end up puzzling over riddles like delayed restriction, disappearing restriction, and/or variable restriction.
DELAYED RESTRICTION
Although the fluid injected into the port during a fill travels immediately to the band, it can take several weeks for you to notice an increase in restriction. This may be because you spend a few days after a fill progressing from liquids to purees to soft to solid food, and then you're extra careful when eating: on the alert for more restriction. When we relax this vigilance, careless eating will eventually remind us (again) that we have a band with more fill in it.
Delayed restriction is frustrating, I admit. You get a fill and want instant results. But all you can do is pay close attention to your body's signals as it adjusts to the tighter fit of the band.
It is pointless to try to judge your restriction in the two to three days immediately after a fill, when you're on a liquid or pureed diet, because optimal restriction is experienced when you're eating solid foods.
DISAPPEARING RESTRICTION
At times during my weight loss surgery journey, I have asked myself, "Where the heck did my restriction go? Did thieves sneak in during the night and steal it?" In addition to thieves and elves, the following things can make your restriction seem to disappear overnight:
1. A few days to a week after a fill, the swelling and irritation caused by the fill calms down and the fit of your band feels looser.
2. In the first few weeks after a fill, you re-learn your band eating skills and unconsciously adjust to the new fill level so that you experience fewer negative symptoms.
3. As you lose weight after a fill, the visceral fat around your stomach shrinks, so the fit of your band doesn't feel as tight.
4. The position of your band against your stomach subtly changes due to normal body processes (see below).
5. Your band loses fluid due to evaporation, leakage, or inadvertent removal during a fill.
Please note that in #1 and #3 above, I said that the fit of the band feels looser or tighter. The band itself does not loosen or tighten by itself. Only a fill, unfill, or manufacturing defect can do that. The band is not like a rubber band that stretches out over time and eventually snaps.
WHY IS RESTRICTION SO VARIABLE?
Sooner or later, every bandster discovers that the band is a fickle mistress. In the course of a week, it can feel too loose, too tight, or just right (kind of like Goldilocks and the Three Bears). The food that worked fine on Monday may get stuck on Tuesday. On Wednesday you can hardly eat at all, and on Thursday you could eat an entire wedding banquet all by yourself. Friday you're back to Square One.
These variations are maddening but fairly normal. The stomach is living tissue that expands and contracts to aid digestion. It's affected by weight loss, the time of day (morning tightness is common), the time of month or fluid retention, medications, illness, dehydration and stress. The pressure of the band against the stomach can cause the stomach wall to thin out, so the band feels looser. And although the band and the stomach are sutured together, the position of the band can shift enough to affect your experience of restriction.
Remember: the #1 factor affecting the amount of food you can eat is what type of food you eat. You will feel more restriction when you eat solid food (like animal protein), less when you eat soft food (even healthy stuff like yogurt and cottage cheese), and virtually none when you drink liquids (even healthy ones like protein drinks).
I asked my surgeon if Fluid dissipates from the band and he said no, not normally. He said that one reason why our bands seem to loosen is because the stomach and esophogus adapt to the band over time. In other words, the muscles in our esophogus and pouch gain strength from having to work more than pre-band. Sounded reasonable to me?
tmf
Very good artical Jean...
Wish I had read this last week when I had a OMG im hungry day !!!
Thanks for this article Jean. You described exactly how I've been feeling. Some days so tight I can hardly eat, next day I want to eat everything in sight (but I don't).
Every day is a new day.
There is another factor that affects restriction: My gastroenterologist told me that he's seen many pts like me who have developed GI motility disorders causing us to feel overly restricted. Also, the stomach can spasm due to being irritated by the band. This feels like tightening, because it is, but it's not your band that tightens, it's the stomach muscle. It's not necessarily a "fickle" band as much as an irritated stomach.
Since going on a low Fiber, low residue diet almost 2 weeks ago, I can eat again and I'm not vomiting, PBing, or otherwise having "stuck" episodes. I'm eating rice, noodles, potatoes, breads. No problems and no weight gain, since my portions are small.
Good question.
My original band surgeon told me that neither the stomach nor the band are fixed, unchanging objects like metal pipe with welded joins and closures.
Dr. Paul O'Brien, an Australian surgeon who is one of the pioneers of clinical use of the band and author of The Lap-Band Solution, there can be a slight loss of fill over time (his example: 7.0ml can drop to 6.7ml in 6 months - a loss of about 4%), not due to leakage. In his book, Lap-Band for Life, Dr. Ariel Ortiz Lagadere reiterates that the band can lose up to 4% of its fill over the course of six months because some Fluid can evaporate.
Has anyone ever proved this fluid loss due to evaporation to be scientifically accurate? I doubt it. I mentioned the possibility of evaporation in Bandwagon and the book was vetted by a bariatric surgeon, Dr. Ross McMahon of Swedish Weight Loss Services in Seattle, WA. I hope that his failure to contradict the evaporation theory gives it a kind of backhanded credence, but it could be that he overlooked it.
Jean, while I respect the skill of the surgeons you mentioned, I am hesitant over their use of this term in it's scientific basis. With that said, I am being nit picky, and don't really care that much. I respect both your experiences as a lapbander and your skill as an author (I bought your cookbook). I am willing to accept that by some process (tiny unicorns using the saline solution to salt their popcorn) Fluid leaves that band. 
evaporation (
-v
p
-r
shn)
The American Heritage® Science Dictionary Copyright © 2005 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
Here's a link to the equation: http://answers.yahoo.com/question/index?qid=20070906130829AAMNrRU
Since the Lapband system is a closed system the amount of evaporation would be minimal, if any. I think the term evaporation is used in a situation where Fluid "disappears" without explanation.
It's so weird that right when I needed to see this is was on my current topics LOL I definitely had delayed restriction. 
Not complaining though glad its there.
Here's a link to the equation: http://answers.yahoo...06130829AAMNrRU
Since the Lapband system is a closed system the amount of evaporation would be minimal, if any. I think the term evaporation is used in a situation where Fluid "disappears" without explanation.
I still prefer the unicorn theory...
Jean, while I respect the skill of the surgeons you mentioned, I am hesitant over their use of this term in it's scientific basis. With that said, I am being nit picky, and don't really care that much. I respect both your experiences as a lapbander and your skill as an author (I bought your cookbook). I am willing to accept that by some process (tiny unicorns using the saline solution to salt their popcorn) Fluid leaves that band.
evaporation (
The change of a liquid into a vapor at a temperature below the boiling point. Evaporation takes place at the surface of a liquid, where molecules with the highest kinetic energy are able to escape. When this happens, the average kinetic energy of the liquid is lowered, and its temperature decreases.The American Heritage® Science Dictionary Copyright © 2005 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
Hey, if I want salt on my popcorn, why should a unicorn make do with unsalted popcorn?!
I had H1N1, that made me really tight and unable to eat (once I could eat). Since, I have had an unfill a partial refill and well I am starting to get back where I was before I was ill. I don't dare complain, because at least I have lost a few pounds through it all and I have not gained. I have noticed that food that are high in sodium tend to cause that awful rumbly grumbly in my tummy. On top of watching sugar carbs and fat, I have learned my lesson and I am staying away from sodium as well (as much as possible).
Jean, Next question for you! How about just eating Edamame for your Protein? Good, Bad or Evil little Soybeans?
Good article Jean, I have had my band for over two years and have experienced eactly what you write about, thus why I chose to learn to eat healthy and have not had a fill in over a year. My band is there and yes it works but I chose to not rely on my band as much as relying on me to practice Portion Control and my own restriction of food. Why did I do this, I read so much on these forums from others about needing a fill, needing to reach their sweet spot, needing to feel more restriction not to eat. For me I had to get control of my head in order to be successful so that is what I worked on ME instead of the band. May not work for everyone but it works for me. Been at goal weight for 5 months and no fills since Jan 2011.
I had H1N1, that made me really tight and unable to eat (once I could eat). Since, I have had an unfill a partial refill and well I am starting to get back where I was before I was ill. I don't dare complain, because at least I have lost a few pounds through it all and I have not gained. I have noticed that food that are high in sodium tend to cause that awful rumbly grumbly in my tummy. On top of watching sugar carbs and fat, I have learned my lesson and I am staying away from sodium as well (as much as possible).
Jean, Next question for you! How about just eating Edamame for your Protein? Good, Bad or Evil little Soybeans?
I love edamame, and they provide Fiber and Protein along with the flavor, but are you asking if it's good to eat edamame as your only protein source? If so, personally I wouldn't do that, for 3 reasons:
1. food boredom always leads me astray
2. my body needs a variety of protein sources to meet my nutritional needs (for Vitamins & minerals)
3. dense animal, fish, or seafood provides better satiety than softer protein sources (like edamame, tofu, cheese, beans)
m1aman 944
Posted
Great article and it is exactly what I have experienced. Thanks for writing it!
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