My Scale is a Liar

I was having a chat with my Mom the other day, and the subject of diets and weight loss came up. My mom is a tried and true weight watcher. She has been on and of program as long as I can remember. We have talked many times about finding the balance everyday, but she insists that her all or nothing approach works for her.

She was telling me how after three weeks of total dedication she lost four pounds. Then she said that she went out to dinner and the next day she had gained two pounds back and was quite upset. She said “I can’t believe I gained two pounds over night. I asked her if she felt she consumed 7,000 more calories at dinner then her body used. And she said “of course not” I said “then ignore it, weight loss is a math problem”

This got me thinking, how often do we live and die by that number on the scale. I have long believed that the scale lies. It turns out it does, or at least sometimes we have to determine the real truth about what the scale is saying.

Crunch the Numbers

By know you may have learned that one pound of fat is 3,500 calories (stored energy as fat). You may also have learned that in order for your body to use stored fat for energy you need to use more energy then you consume in food. This is were the numbers come in. You need to first have an idea how many calories your body needs just to maintain it’s current weight. A good way to determine this number is simple, if you are not losing weight and you are not gaining, you are at energy balance.

A good way to find out what that number is in calories is by keeping a food journal. I know that journaling is a pain in the you know what, but you only need it for a while while you do your calculations. Track what you eat and how much for one week. You may need to do some weighing and measuring at first to make sure your portions are accurate. Add your total calories daily. Shoot for maintain your current weight.

If your calories (for women) for example total 1,600 daily this will help with determining how much weight you can expect to lose each week.

Ok, so we know that 3,500 calories is equal to one pound fat. So in order to lose weight at a the rate of one pound per week, you would need to cut your total calories per day by 500 calories. That is as simple as cutting out one mocha latte, a piece of pie or margarita.

From this point it is really up to you how fast you want your weight loss to progress. For some a steady weight loss of a pound a week is easy to maintain and may be the right choice if you like more flexibility and less stick approach. This is not a bad way to get to goal, it just takes longer.

So from our example above your numbers look like this 1,600 – 500 = 1,200 calories total daily to lose one pound per week.

Which brings me to the more aggressive two pound or more a week approach. Lets say your energy balance is 1,600 calories a day, and you determined that dropping your calories by 500 a day will yield a one pond weight loss per week. But you want to lose two pounds per week.  It is not recommended to reduce your daily calories below 1,200 daily. By doing so, you can actually make it harder to lose and keep the weight off. You don’t want your body to revert back to it’s cave man roots and go into survival mode by reducing your metabolism and thus your energy needs. It is a much harder process to re build a sluggish metabolism and is a long road back to losing weight again.

OK so the answer should be becoming very clear now what has to happen.

EXERCISE! if you can’t risk lowering your calories further, you need to add exercise to your equation. Your body will work with you to help you lose weight when exercise is in the equation more the just calorie reduction alone. In fact regular exercise will cause the body to have more energy stored in muscles for more efficient use rather then storing in the body as fat. You can train your body to use what you eat rather then store it.

To get back to my mom, after talking with my mom some more, I found out why her weight increased over night. She had started to exercise recently and was extremely sore. She had a particularly high sodium meal at dinner the night before. And was on a new medication. All of which contributed to her increased weight.

So before you let your motivation fissile out from a unexpected gain. Know your numbers, do the math! if something doesn’t seem right. Do some detective work by using your food journal. Remember weight loss is a math problem. It’s up to you to solve it.

Build Success by Appreciating your Progress

Losing weight means your self-image is in flux, how your body is changing often reflects how you feel on the inside.
No matter where you are on your journey, it’s actually not hard to make slight adjustments in your behavior and thinking to help you to feel skinnier, and therefore more successful and motivated. Feeling good helps keep you on track, so feeling good is incredibly important. The skinnier you feel, the less you’re interested in temptation.

The path to feeling good is not as overwhelming as it might seem. You begin in one area of your life and then as healthy new habits become routine for you, you build new behaviors in another. Small victories build and soon you’ll find that the time you put in to caring for yourself pays off big time.

Try these skinny feeling  tips…

Have lots of ways to measure progress.

Clothing fit, tape measure, BMI, journal review, energy levels, exercise levels, etc. The idea is that you no longer live and die by the scale and you maintain a positive sense of success whether the scale says so or not.

Keep slightly snug clothing around to try on regularly.

Obviously, this shouldn’t be your whole wardrobe, you know! But you will regularly surprise yourself by fitting easily into something you didn’t know you could!

Always have a few outfits that you look and feel great in! Important to experience the positive outcome of your work so far; nothing motivates like success!

Stay hydrated.

Keeping up on your water will help you stay more fit, plus you’ll feel better and your skin will be softer. You don’t tend to bloat when you get plenty of H20, and it helps those losses flow. It’s good stuff, Sparky!

Forget lose-by dates.

If you miss the mark by even a few ounces, you end up feeling like a failure. Instead, set moderate, healthy behaviorally-based goals that you have control over and celebrate each step in that direction.

Look at old pictures, and take some new ones.

When you’re losing weight, your body image is in a state of flux all the time. It’s hard to judge what size clothes you wear sometimes; some days, you’ll feel gloriously thin. Others, like a river barge. Pictures help ground your self-image while your body is in motion.

Try different styles

Be a little more daring that you usually would. It’s fun to be vain, and it’s good for you to experiment with different styles. You’ll find as you go along your old style doesn’t fit you anymore, in every way.

Take your vitamins.

Of course, you’re eating well, right? But even so, a good Multivitamin, at least, will make sure you’re getting what you need and help keep you feeling perky and energetic. Definitely, energetic feels skinnier!

Compare stats

If you’re tracking lots of things, it can really help you feel skinnier to acknowledge how far you’ve come. Reading old journal entries, comparing medical stats, reviewing BMI, or whatever the heck you look at, do a little before/after-ing. It can give you a wonderful reminder how far you’ve come.

Encourage others.

It keeps your vibration high and clear, and gives your brain time focusing on positive, helpful info. Win-win, baby!

Here’s wishing you all a very skinny day, and many more of ‘em!

Are you resolved to lose weight?

We all know that changing our habits to more healthy ones is our goal that leads to our weight loss success, Right! But how do we get it going and keep it going? That seems to be the big issue.

Let’s start with what exactly are the things that need changing or adjusting. Yes, that means writing it down. Make it real!

Challenge yourself for real changes you can put into action, not lofty ideas that you know you can’t maintain. What are the baby steps to real change? Try these healthy eating resolutions that you can maintain all year.

Healthy Eating Resolutions

I want to be successful

Make one small, specific healthy eating goal at a time and then reward yourself for meeting it. Don’t overwhelm yourself by making many changes at once. Post reminders where you can see them every day. Try not to reward yourself with foods that undo your healthy eating habits. But find some other way to celebrate meeting goals. How about gourmet herbal teas or a massage?

I want to snack healthier

Eat one more healthy snack a day. Instead of reaching for cookies or chips, enjoy a small handful of nuts or trail mix, or low-fat yogurt. Take advantage of fresh fruit in season.  Eat pretzels or a few whole-wheat crackers with low-fat cheese. But only snack when you’re really hungry — not just bored or stressed — and only eat one serving.

I want to eat smart at restaurants

Just like eating at home, planning can help you make smarter choices in restaurants. Find one that serves a children’s menu or smaller portion sizes. Don’t let yourself get so hungry that you overeat. Have a healthy snack beforehand. Or start with a clear (not creamy) soup or salad. Cut your meal in half and take one half home. Or split an entrée with a friend. Ask the waiter not to bring any bread or tortilla chips to your table.

I want to eat less fast food

Try to reduce fast-food temptations. Take a different route to avoid seeing drive-through restaurants. Keep fruit or nuts with you to tide you over until you get home or to work. If you can’t resist, choose lower-calorie options like grilled chicken or low-fat chili. And look for fruit or veggie options like a plain salad or baked potato as a side. Order regular or small sizes, and avoid value meals. Sip water instead of soda.

I want to snack less at work

Get unhealthy snacks out of your office — or at least out of plain sight. You’ll eat less if you don’t have food within easy reach. If you tend to graze mindlessly at work, don’t keep food at your desk. Keep it at least 6 feet away from where you sit. The distance makes you think each time you grab a bite. Take time for a real lunch break, away from your desk.

I want to plan to eat right

Don’t give up on healthy eating just because you’re out of time. Have a healthy-eating plan in place for days when you work late or have errands to run. Keep nutritious snacks with you, like trail mix, whole grain cereal, or fruit. Keep healthy foods in your freezer. Learn which restaurants and supermarket delis have salad, soup, or grilled chicken so if you have to eat “to go,” you can make healthy choices.

I want to eat more fruits and veggies

Eat at least one more vegetable or fruit at every meal. Keep cut-up raw veggies in the front of the fridge and fruit on the counter where you’ll see it. Have healthy dips on hand, like hummus, peanut butter, and low-fat yogurt. Load extra veggies into your sandwiches, pizzas, salads, soups, and omelets. Pureed veggies like butternut squash can thicken soup and other dishes and add nutrients to them. Mix cauliflower puree in with mashed potatoes.

I want to eat smart at parties

Eat a healthy snack before you go, so you won’t overeat at the buffet. Fill a small plate with at least half fruit and veggies. Limit your portions of desserts and high-calorie dishes to just a taste — a bite or two. Once you’ve eaten, step away from the food. If you have a conversation around the buffet table, it’s too tempting to just keep snacking. Drinks can be high in calories, too. If you’re drinking alcohol, use moderation.

I want to avoid mindless eating

Eat only when you’re actually hungry. When you feel satisfied — but before you feel full — stop eating, even if there’s still food on your plate. Don’t sit in front of the TV or computer when you eat. Multitasking leads to overeating. Pay attention to your food. When you tune in to your appetite signals, you’re less likely to eat just because you’re bored.

I want to eat breakfast every day

If you’re too rushed in the morning to make breakfast, take it with you to eat at school or work. Portable breakfast items can include granola or breakfast bars, containers of yogurt, instant oatmeal packets, or pieces of fresh fruit. Muffins, bagels, and other baked goods are often larger than a single serving — consider portion sizes carefully. Even if you don’t like typical breakfast foods, it’s important to eat something in the morning to fuel your body.

I want to keep track of what I eat

Keep a food journal to pay attention to what you eat and how you feel when you eat it. You may be surprised by your eating habits. You can write down your meals or download an app for your smart phone or tablet. You don’t have to track your meals every day. Just track it one day a week or for a few days to get an idea of what and how you eat.

I want to learn to say “No”

Stay strong when it comes to healthy eating. The waiter might tell you that you can’t have sauce on the side. Your coworker might pressure you to try her homemade treats. Remember that every bite adds up, so it’s important not to give in over and over. Explain why you’re saying no if you want to — or just politely decline. You don’t owe people an explanation, but you owe yourself good health.

I don’t want to overeat

Think small. Trade your large plates and silverware for small ones. We eat 22% less on a 10-inch than a 12-inch plate. Use a tablespoon, not a serving spoon, to dish out portions. Think about what you put on your plate to make sure you really want it. Serve from the stove instead of the table, so second helpings aren’t right in front of you. Eat slowly so your body has time to tell your brain you’re full.

I want to find support to eat healthy

It’s easier to be strong when you have family or friends on your side. Ask a buddy or family member to eat healthy with you. Hold each other accountable. Don’t make healthy meals or snacks just for yourself but let your family eat what they want. Everyone should eat healthy. Then if someone is tempted to slip, the whole team is there for support.

I want to dine out less

Plan every day so your only option isn’t a restaurant. Use a slow cooker so a hot, healthy meal is ready and waiting for you when you come home at dinner time. Cook more than you need, and freeze half. Then you’ll have frozen meals you can take out whenever you need them. You can even make easy-to-fix healthy breakfasts — like oatmeal with fruit — for lunch or dinner.

Putting together your Weight Management puzzle

The 10 lap band rules were established to guide patients to the eating and behavior modification that is necessary for the care and function of the Lap Band to aid in weight loss and weight management. Sort of like your cars ownership manual helps you to care and maintain proper use of your vehicle.

The 10 Lap Band Rules for the most part are common sense practices to healthier eating, and are a good set of guidelines for everyone, not just Lap Band patients. But for patients that have had Lap Band Surgery it is especially important to follow these rules to prevent complications.

Following the band rules will assist in:

A healthy weight loss (average of 1-2 pounds a week)

Improved eating habits and lifestyle

Ability to maintain your weight loss

Improved nutrition and fitness level

Avoidance of complications associated with proper use of the band

The Lap-Band rules are not hard to follow, but, can take some time to become a habit. You will need to adjust habits that you have been doing all your life and may be hard to break. It is very important after surgery to become very familiar with these rules and follow ALL, not just some, but all the rules for your continued success as a banded patient.

The Lap Band Rules are at the center of your weight management puzzle.

Weight loss begins when you start putting together the Weight Management puzzle. And continues, the more pieces you put together. Remember, it takes time to change old habits. You will  need to be very diligent at practicing following the rules. But with daily practice these rules will become second nature. Having a copy of the rules in a place to remind you (like the refrigerator) is recommended.

 10 Lap Band Rules

1. Eat only three main meals a day, plus two planned snacks.

2. Eat slowly, taking very small bites. Chew thoroughly until your food is a mushy consistency.

3. Limit your food portion to no more then ½ c to 1½ c.

Stop eating….

• If you feel restriction from the band.

• Feel satisfied,full or no longer physically hungry (this will feel different from the “full” sensation you had prior to your surgery.)

• You have eaten ½ to 1½cup total volume of food

4.Do not drink with meals, or for one full hour after eating.

5. Do not eat between meals, or planned snacks.

6. Eat a variety of high quality nutritious  foods.

7. Consume recommended amounts of fiber daily.

8. Drink 64-100 ounces of non-caloric fluids between meals.

9. Do not drink carbonated beverages of any kind.

10. Exercise 30-60 minutes on most days.

If you are having trouble following the rules we are happy to assist you. . You are not alone. We are here to help you.

When you became a patient of Dr. Kuri, you are considered a patient for life! One of the special rewards of Dr. Kuri’s practice is to keep in touch with his patients and share in their success after surgery. In an effort to relieve some of the burden of cost involved in his patients returning back to see him, he offers his patients free fills for his services for life. This also allows the patient to ask questions and be reevaluated if necessary.

Scheduling a fill appointment

Scheduling a fill appointment is easy. Simply call the office toll free at 1-888-223-4046 or toll free from Canada at 866-782-5042 to determine availability and reserve your appointment. Appointments are made as a first come first serve basis.

Fills using fluoroscope

Although Dr Kuri does not charge for performing the fill, if you require the use of the hospitals fluoroscope there is a charge of $95, payable to the hospital at the time of the appointment. Hospital Angeles accepts the following forms of payment; cash (Dollars and Pesos) American Express, Visa, and Debit cards.

What days are available for fill appointments, and who performs the adjustments?

Fills are offered on most Tuesdays and Thursdays and Dr. Kuri makes himself available to his patients for fills one Saturday a month (call office for Saturday appointment dates) In addition to Dr. Kuri, fills may be done by Dr. Gabriela Morales and Dr. Francisco Espinosa. If you need to speak to Dr. Kuri with concerns or questions, make sure you request to speak with Dr. Kuri when you make your appointment so they can give you the extra time you need for your appointment. It is important to make sure you have an appointment before making plans to travel down for a fill.

Fills are performed at the beautiful state of the art Hospital Angeles

Note: Patients are responsible for arraigning their own transportation and cost for fill appointments.

Biscotti are one of my favorite desserts and a perfect after diner treat with a cup of coffee. Spend the time making a batch of these crunchy, sugar-free cookies — they’re well worth it and just as fantastic as ones made with white flour.

View Recipe Gallery

Chocolate-Hazelnut Biscotti

Prep Time: 20 mins

Cook Time: 40 mins

Total Time: 1 h 10 mins

20 Servings

INGREDIENTS

1 1/2 cup(s) flour, whole-wheat pastry

1 cup(s) sugar substitute

1/2 cup(s) cocoa powder, unsweetened, preferably Dutch-process

1 1/2 tablespoon espresso, instant

1 teaspoon baking soda

1/4 teaspoon salt, Kosher

2 egg(s)

2 egg white(s)

2 teaspoon vanilla extract

1 teaspoon almond extract

1/4 cup(s) nuts, hazelnuts, toasted and coarsely chopped

PREPARATION

1. Preheat the oven to 300ºF. Line a large baking sheet with parchment paper or waxed paper.

2. Sift the flour, sugar substitute, cocoa, espresso powder, baking soda, and salt onto a piece of waxed paper or foil. In a large bowl, combine the eggs, egg whites, vanilla, and almond extract. Beat with an electric mixer set on medium speed. Reduce the speed to low and gradually add the flour mixture until a stiff dough forms, adding the hazelnuts when the dough is about half mixed.

3. On a floured surface, divide the dough in half. Form each half into a 12″-long log, pressing down the top slightly to a 3″ width. Transfer the logs to the prepared baking sheet, placing them an inch or two apart. Bake until almost firm to the touch, about 40 minutes. Remove from the oven and let cool for 10 minutes.

4. Using a spatula, carefully transfer the logs to a work surface. Using a serrated knife, cut logs on the diagonal into 1⁄2″- to 3⁄4″-thick slices. Arrange the slices, cut side down, on the baking sheet. Return to the oven and bake 30 minutes longer, turning once halfway through. Cool completely on a wire rack. Store in an airtight container in the refrigerator for up to 2 weeks.

Diabetic Exchanges: 1⁄2 starch

Amount Per Serving

Calories: 40

Total Fat: 1 g

Saturated Fat: 0 g

Cholesterol: 14 mg

Sodium: 73 mg

Total Carbohydrate: 6 g

Dietary Fiber: 1 g

Protein: 2 g

Sugars: 0 g

View more Recipes:  Recipe Gallery

An adjustment, or ”fill” as it is more commonly known, is adding fluid to the band around your stomach. This adjustment tightens the band and makes the opening between the upper and lower portions of the stomach more narrow to slow the rate of food passing through and allow you to become satisfied and no longer hungry faster. This allows you to eat less food then you would normally consume so you take in less calories.

An adjustment can also mean an “un-fill”. This is done if a patient has a too tight fill, has become pregnant, or for personal reasons has requested an un-fill.

How many fills will I need?

Generally most patients require one or more adjustment during the first year to get a “just right” fill. It’s a bit of a trial and error. Every patient is different as to how they will tolerate different fill levels.

Dr. Kuri or your fill provider will determine the right first fill level for you. Subsequent fills will require your feedback as to how you are tolerating your fill.

See Is Your Band too Loose, too Tight or Just Right?

What is a Fluoroscopy?
It is advisable to always have a fluoroscopy when getting a fill. A fluoroscope is just a form of a moving X-ray. The picture shows up on a monitor where the doctor can watch fluid pass through the band, and determine how much restriction is required. Some patients due to a large amount of tissue around the port site may require fluoroscopy to help locate the position of the port making it easier to do the adjustment.

Preparation for Lap Band Fills

There should be NO food in the upper pouch when a patient arrives for their lap band fill. It is suggested that only liquids be ingested on the day of the fill procedure to flush the stoma and ensure that there is no food remaining in the pouch.

How is an Adjustment done?

Lap Band fills are performed at our facility along with a fluoroscopy. This test allows the surgeon to see the band placement and stomach before and after administering the fill, to ensure that the fill amount is sufficient to provide the restriction level required for continued weight loss. The procedure takes no more than 15 minutes on average and is relatively painless.

To do the adjustment a fine specialized needle is passed through the skin into the port to add or remove saline.

Local anesthesia may or may not be needed. Most patients find that a fill is relatively painless and similar to getting your blood drawn.
The doctor may have you raise your head or feet to contract the abdominal muscles, to make the port easier to feel. The adjustment process normally takes only a few minutes.

Bringing some water with you is advisable. After the adjustment is done You will want to try drinking some room temperature water before leaving the X-ray dept. This is not a guarantee that your fill level is correct, but if water does not go down it is likely that you are too tight and can save yourself a second trip to have fluid removed, by testing this right after the adjustment.

If you have traveled some distance for your fill,  You may want to stick around the area for several hours to make sure everything is OK.  This will save you the time and expense of a return trip.

Recovering from your adjustment

When you leave the office if you vomit the water you drank after your fill, it will not get better. Please, turn around and come back to the office, we will take some fluid out.

The first few hours drink only liquids. If you cannot tolerate thick liquids – we need to remove some fluid. If you do tolerate a meal of thick liquids then try some soft food. After the 24 hours go to solid foods but remember to measure your portions.

Your band will be tighter so eat slowly and very small bites.

Your stomach may have swelling around the band or get a bit irritated from the fill; however, this should pass in a few days. You should always be able to take in sufficient fluids. If not, you need to return to let fluid out.

Like Goldie Locks exploring the three bear’s house, do you find yourself wondering if your band is too loose, too tight, or just right? Do you feel sometimes like the perfect fill level can sometimes be a bit confusing? Well, you are not alone. When you consider all the different things that can influence how your band will feel, unraveling the mysteries can be a challenge.

Is Your Band too Loose, too Tight or Just Right?

If your band is too loose you will be able to eat larger meals, be searching for food, and not have adequate weight loss. If the band is too tight you might not be able to tolerate solid food, like meat, and find yourself eating soft, mushy foods — like mashed potatoes, soups, or other high calorie items.

Working with your fill provider

Although doctors and fill providers make every effort to give their patients a perfect fill level every time, it is not always possible to predict how a patient will respond after receiving a fill adjustment. There are however, certain things that can be done to increase your chances of getting a good fill the first time and every time.

The Fill Process

If you will not be having your fills done by Dr. Kuri, there are some things we recommend you consider. Some fill providers will encourage you to purchase a “fill package” or fills given on a regular schedule. We recommend you do not purchase fills that are made on a regular schedule (such as six fills in the first year). The reason is simple; you may not need six fills in one year. Making pre-scheduled appointments, can lead to over filling the band. Trust me you don’t want to go on the “fill, un- fill roller coaster”. With budgets getting tighter these days, these fill packages seem like a good deal, but you could end up spending more time, money, a loss of forward progress and worst of all complications from over-filling the band. First fills and all subsequent fills are not given on a routine basis. Instead, they are given according to your individual needs. In no case should a fill be given before 6 weeks post band surgery.

Adjustments to the band are made to allow the band to suppress appetite for a prolonged period of time. Adjustments are not meant to MAKE you stop eating. The band is a guide, it is not a collar.

We do not like “hard stops,” that is, where you eat until you “feel like you can’t possibly eat another bite” We do not use the word “restriction,”  restriction would be a “feeling,” and we do not subscribe that you should feel pain or pressure to stop eating. The band does not work by “feeling restricted,” and those who seek that term have difficulty maintaining a good fill level and typically do not lose the weight they should .

Make sure you are ready for a fill

Fill providers vary in their experience and service they provide. Good communication between you and your fill provider can make the difference between a good fill and a not so good fill. Fills can be done quickly, usually fifteen minutes is all it takes to receive a fill. This does not leave allot of time for a long conversation with your fill provider. Your fill provider is going to assume you have considered all the variables in determining that an additional fill is needed. Unfortunately most fill providers don’t have the time to question you to find out if you have considered all the variables that would determine if a new fill is needed, such as current food selection, lifestyle and amount of weight loss since your last fill.

Self assessment

One of the benefits of the Lap Band is to be able to adjust the amount of fill (saline added to the band) needed as weight loss continues. However, with a strong desire to lose weight it is easy to misuse this valuable advantage. Patients often have the “more is better” mentality. Lack of continued weight loss is not the only determining factor for receiving an additional fill. Before you make your next fill appointment, you need to do a self assessment of the lifestyle and diet changes needed to help the lap Band do its job in encouraging weight loss.

Ask yourself these questions:

Am I focusing on eating a healthy balanced diet? Or do I frequently eat sweets, higher fat foods and liquid calories?

Am I using good portion control, limiting my portion size to no more than ½ to 1 ½ cups of food at a meal? Or do I frequently rely on the band to stop me from over eating, but seem to eat a larger meal when I want to?

Am I consistent about eating fiber rich foods such as vegetables and fruit? Or do I get less than five servings a day?

Do I spread my calories throughout the day? Or do I skip breakfast and tend to eat more in the latter half of the day?

Do I plan out my meals and snacks ahead of time to make sure I am getting a balanced diet? Or do I eat what is convenient and fast, with very little planning?

Am I getting the recommended 30 to 60 minutes of exercise and physical activity on most days? Or has my exercise routine been more of a hit or miss routine?

Am I consistent about following the 10 Lap Band rules? Or do I only follow the ones that I want to?

More fill will not help your weight loss if these Lifestyle and diet issues are not addressed.

These questions and more would be what every fill provider would ask you if they had the time to ask you. This is why it is important for you to take the responsibility assessing your habits before you determine if another fill is needed.

You know you need a fill when a small amount of food is not lasting you an appropriate period of time.  When you find yourself looking for food — and feel as if you are dieting.

When to avoid receiving another fill

It is a common mistake to think that a really tight fill will improve your chances at weight loss. That is simply not the case. There is no advantage gained by having a too tight fill, and in many cases can cause many problems and disappointment in your results.

If you are having any trouble with your current fill such as regular pain or excessive pressure when eating, frequent vomiting episodes when eating or right after eating, reflux problems, not able to drink fluids or fluids that seem to take too long to pass through the stoma, unable to eat solid food or more than a couple small well chewed bites at a meal, then you are not a good candidate for a fill at this time. Rather you should consider needing a un-fill to improve any of these problems.

There are several reasons to have pain after eating:

(a) Eating too much. When you stretch the pouch you may experience pain. This is your body warning you that you have eaten too much, especially if you have pain in the left shoulder. This means the pouch is stretched. Remember, the volumes we express are not the minimum to eat but the maximum. Successful patients eat a portion and walk away. Do not eat until you “feel full.” Your band will slip if you chronically overeat your pouch.

(b) Eating too fast. When you eat too fast you can cause pain in the pouch. This also leads to eating too much. Successful patients eat slowly over 15 to 20 minutes. Unsuccessful patients tell us that they don’t have time to eat — and yet manage to get more calories in than they need. Eat slowly. Slips happen when patients eat too fast.

(c) Eating too large a bite. Slow down. Take your time. Put nothing in your mouth larger than the fingernail of your smallest finger. If you eat too large a bite things can become stuck. If you eat too large a bite it can become lodged into the pouch and cause discomfort and lead to a slip.

See How to Chew Food Properly

When food becomes stuck

It will feel like a golf ball underneath your breast bone. You may be in pain. You may not be. You may “slime” and produce a lot of saliva in your body’s attempt to dislodge this.

Things that become stuck:

Chicken is the worst offender, especially chicken that has been microwaved. Re-heating chicken tends to make it so that it will be too tough. Chicken with other things that get stuck are also a culprit — chicken and rice, chicken and noodles, or chicken and tortillas or other bread type of products.

To make chicken so it won’t get stuck:

Use a meat hammer and pound it.

DO not overcook it so it is dry.

Marinate the chicken.

Slow roast.

Breads, pasta, rice — all can become stuck.

Vegetables that are fibrous — humans do not digest the methyl cellulose in vegetables. So, cut the vegetables so that the fibrous material does not sit in your pouch obstructing things periodically.

Best way to not get things stuck:

Avoid the problem. Chew well. Eat slowly. Do not overeat. Avoid dry chicken or re-heated chicken .

If something gets stuck: Stop eating. If it burps or vomits up — good. IF it is stuck for more than 20 minutes then do not eat for 24 hours. Instead go on liquids. Once something is stuck for a while it will cause the stomach lining to thicken, so you will be prone to have things stuck.

To help get things unstuck — stand up, walk, jump. It will pass. If it does not — you may need to take fluid out of the band.

How to prepare for a fill adjustment

Keeping yourself well hydrated is always important, but even more so, when you are going to receive a fill. Keeping hydrated will help prevent your stoma from swelling and improve the accuracy of your fill. Start several days before your appointment, making sure you are taking in 64 to 80 ounces of fluids daily. If you engage in strenuous work or exercise, make sure you replace fluids with extra water. Avoid foods with excessive amounts of sodium, as these foods can have a dehydrating effect on the body. Stick with no-calorie, non-carbonated beverages or just plain water.

Eating before a fill

To receive a good fill requires that your pouch is empty. For this reason you should not eat solid or soft foods 2-4 hours before your fill. Full liquids are fine in small amounts, but discontinue 2 hours before your fill appointment.

Avoid eating a heavy, spicy or a late meal the night before. Avoid eating anything that may cause you to have a PB episode. You want your stomach to be as peaceful as possible.

Relax

Relax and get a good night’s rest, there is nothing to worry about. Receiving a fill is very routine. It is similar to getting your blood drawn. We want you to be calm and relaxed for your fill. Stress can cause a false tightening of your stoma, and can make it harder to get a good fill.

Ladies check your calendar

Bands are tighter anytime you have swelling — when you are ill,or if you have allergies. Avoid scheduling a fill during your menstrual period or several days before, as you may be retaining water at that time. This may reduce your chance for a good fill. It is unwise to receive a fill during these times.

Recovering from a Fill adjustment

The first 24-48 hours following a fill should be considered a period of recovery. The stomach as a rule can be a very grumpy organ, any small change and the stomach will react with swelling. Your results from your fill may not be apparent for a couple of weeks. It can take 1-2 weeks for your stomach to return to a more settled condition. It is important not to force food through the smaller opening. Any irritation will delay your recovery. You may also end up needing a un-fill if you continue to irritate your stomach. It is important to remember that your latest fill adjustment changed the size of the opening through the stoma. Many of the foods you were able to eat easily may now give you some trouble. A slow approach is recommended and taking small bites and chewing your food thoroughly becomes more important than ever. This is a good time to refer back to the post-op diet you were given when you first had your surgery. Pay close attention to the sections on full liquids, soft foods and introduction to solid foods. You may also want to take this time to remind yourself of the 10 Lap-Band rules.

Keep yourself hydrated

Keeping yourself properly hydrated after your fill is important to the recovery phase. It is also a good indicator of how your new fill feels. After your fill you should be able to drink room temperature water with no problem. If you can’t get water down you may need a un-fill. It is recommended that you stay in the lobby for awhile after your fill to make sure you can tolerate your new fill level. You don’t want to be traveling home before you realize you are too tight and need to return.

Traveling Home

If you have traveled some distance to receive your fill, you may consider staying the night and leave the next day. This will give you a chance to test your new fill level with some full liquids and possibly a bite or two of soft foods, before you get on a plane or start a long drive back home. This will save you the inconvenience of having to return for a un-fill.

24 – 48 hr. recovery diet

Just like after your surgery you are going to ease back to solid food again. Except this time you will complete it in 2 days. Stay on full liquids for the first 24 hours if you can. Full liquids are liquids that can easily go through a straw. If you did fine with full liquids you can move on to soft foods. Soft foods are foods you could eat if you had no teeth. Use good judgment; if you have had no trouble at this point you can slowly introduce soft cooked solid foods again.

Testing your new fill level

If you have completed your 48 hour recovery diet, and have had no problems, you should start to test your new fill level by eating a typical Bandster type meal. A typical Bandster meal will consist of 2-4 ounces of soft-cooked solid protein followed by a 1/2 cup of vegetables. This meal should be able to keep you satisfied for 3-5 hours. If you cannot eat moist solid protein, and can only eat soft foods or liquids then you may be too tight. If this is the case, don’t make the mistake of eating “easy foods” to get by. You will find that “easy foods” can easily be over eaten defeating the purpose of the band. Patients that go this route will train themselves to eat around the band and actually gain weight, leading to disappointing results.

The slow approach is better

Your approach to receiving your fills should be slow and gradual. Although patients vary as to how many fills they may require. The key is to gradually introduce some pressure and restriction to give the patient time to adjust their eating habits and promote a perfect fill level for sustained weight loss. If this is your first fill experience, or one of many you may have had, good preparation before and a little maintenance after your fill will greatly improve your chances for a successful fill.

Planning is everything when trying to lose weight and establish new healthy habits. But putting together a healthy balanced menu can be difficult until you get the hang of it.

These tips will lay out the basics of structuring a healthy menu and help on your road to healthier eating.

Your calories from food come from three main categories Carbohydrates, Proteins, and fats. All three food categories are necessary for the body to be healthy. Although carbohydrates and fats sometimes get a bad rap for being the cause of weight gain, it is eating too much or choosing the wrong ones that is usually the problem.

Breakdown of a 1200 calorie diet

Carbohydrates at 55%

1200x.55=660 carb calories

660/4=165g

Proteins at 20%

1200x.20=240 protein calories

240/4=60g

Fats at 25%

1200x.25= 300 calories

300/9=33g

Note: In this example we are using 1,200 calories.  Your calorie needs may differ depending on sex, age, and activity level. 1200 calories is the minimum amount of calories recommended to safely lose weight over an extended period. Men and very active women may need to add additional calories to meet their particular needs.

Let’s take a look at those food groups that make up our nutritional requirements

Protein: 5 to 6 ounces from lean sources.
Chicken/turkey (no skin white meat preferred)
Beef – ground hamburger, steak, etc as lean as possible (remove any visible fats)
Pork – lean cuts only like pork tenderloin, ham. No sausage, bacon, pork chops (remove any visible fats)
Fish – try to eat at least two meals of cold water fish weekly, such as Salmon, mackerel, anchovies, sardines, and herring (SMACH) these fish have a high level of Omega 3 fatty acids, and are essential to a healthy diet. Other fish is also except-able, as long as it is not breaded or deep fried.

Vegetables: minimum of three servings (you can have more as long as you do not add calories to cook or eat them)

Serving size = ½ cup cooked or raw vegetables or 2 cups leafy green vegetables.

Think color and variety when selecting vegetables and fruit.

Fruit: two to four servings daily.

Serving size = ½ cup cut up fruit or whole fruit (apple) no bigger than a tennis ball.
Think color and variety

Grain: two to three servings daily

Serving size = 1 oz. (average sliced bread) or ½ cup cooked brown rice, wild rice, quinoa, or other cooked grain. ½ cup Cooked or cold cereal (check cold cereal box nutritional facts label some cereals are heaver then others)
Choose only whole grain sources (check labels carefully, look for the words “whole grains” not just whole wheat or wheat flour)
Choose a cereal with 5 grams or more of fiber per serving.

Oils: 5 teaspoons worth of total fats and oils from all food sources
That includes any fat found in the meats, grains, vegetables, you eat and any added fats you add to cook or enhance the flavor of your food.

Be careful these foods add calories up fast with a small volume of food. Even healthy fat sources contain 9 calories per gram of weight.

Organizing your meals during the day

How we structure our meals has a big effect on when we will get hungry. And can make a huge difference in our weight loss efforts. Every meal you eat (or don’t eat) effects the next meal you will eat. So planning your meals you will be eating in advanced can be a very impotent component to your weight loss efforts. Knowing what to eat and when will help you feel yourself becoming naturally hungry and satisfied throughout the day.

Every meal you eat (or don’t eat) effects the next meal you will eat

Breakfast sets the tone for the rest of the day.

Research shows that breakfast skippers have trouble with late day eating and constant snacking. Eating breakfast helps you to make better choices during the day.

Start your day with fiber in mind. Fiber is a POWER HOUSE when it comes to appetite control.

Fiber slows digestion and helps to keep you feeling full and satisfied between meal periods

Bandsters tend to be a little tight in the morning.

Replace lost fluids before eating breakfast.

Start with a warm beverage, Warm beverages helps reduce morning tightness and can make it easier to eat breakfast.

Breakfast ideas: choose one of the following

4 to 6oz non-fat or low fat yogurt (Dannon light and fit fat -free or Dannon light and fit fat-free, carb control has less sugar) with ¼ cup low sugar granola, or low sugar cereal, with 2 tbs. sliced almonds/walnuts. You could also 2 tbs. dry fruit or add fresh fruit.

½ to 1 cup cold cereal, with 4 to 6 ounces non-fat or low fat milk. With two tbs. dry fruit or 1 serving fresh fruit.

½ cup cooked oatmeal (or high fiber cereal) cooked with non-fat or low fat milk (4 to 6 ounces). With I serving fresh fruit or 2 tbs. dry fruit. And two tbs. almonds, flax seeds or walnuts.

1 to two eggs, (two eggs if using egg whites only) or ¼ cup egg substitute. With ½ ounce low –fat cheese. 1/4 cup veggies (for omelet or breakfast burrito ) and 1 slice whole grain wheat toast or tortilla.

Lunch and dinner

Lunch and dinner meals are about the same as far as their components and structure.

Choose from 2 to three ounces of lean solid animal protein or ½ cup beans, legumes or soy alternative.  With ½ to 1 cup cooked or raw vegetables. And if you have the room you can add ¼ to ½ cup grain serving (provide that you have not eaten all your grain servings for the day)

Here is a trick to help size out your portions Use a 7” plate (try a paper plate for this demonstration) draw a line through the middle, creating two halves. In one half, write “vegetables ½ cup. Then draw a line through the other half section, creating to quarter sections. In one quarter section, write “protein 2 to 3 ounces. In the last quarter section write grain ¼ cup.

This is an example of what Lunches and dinners should look like.

Always start with your protein source. Cut it up ahead of time into tiny tip of your baby finger bite size pieces. This will remind you to slow down and chew your food completely. After eating the protein, follow with eating the vegetable. And if you are not full yet you can then eat the grain portion. Even if you eat all of this measured food in the larger volumes you will not exceed 1 1/2 cups total volume of food. We need to use good old fashion portion control, until we get a fill level that will help us with that.

Healthy  Meals

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Grill a chicken breast, slice it up and spread it over a bowl of mixed greens. Add some tomatoes,and other colorful veggies, drizzle with a light dressing.

Kabobs are fun and easy to make. First, choose what you type of meat or seafood you’d like to use, and then chop up some onions, bell peppers and zucchini. Slide each piece onto a skewer, grill your kabobs and enjoy

When it’s hot outside, nothing tastes better than a tortilla stuffed with blackened cod, salsa verde and chopped fennel and cabbage.

Use Snacks to control hunger and fill in nutritional gaps

Strategically placing snacks at critical times during the day, helps prevent over eating at your next meal.

How does snacking help with over eating?

Use the rest of whatever choices you have left from the various food group requirements to fill in the gaps for strategic snacking. (Between breakfast and lunch, lunch and dinner, or save it for an after dinner snack, if you tend to need a little something in the later part of the day.

Sample snacks 

Fresh fruit, fruit smoothie, yogurt and fruit, yogurt and granola, apple and peanut butter, Triskets and peanut butter, low-fat string cheese, low fat or air popped pop corn, ¼ cup almonds/walnuts, non – fat or sugar free jello or pudding, vegetable soup, raw veggies and hummus dip.

Super Snacks With 100 Calories or Less,  Snack time superstars

These are small; tide you over snacks, not an all out binge. So stay within 100 to 200 calories.

Half an Apple With 1 Tablespoon of Peanut Butter

10 Carrot Sticks With 2 Tablespoons of Dip

Popcorn

One-Quarter Cup of Almonds, Cashews, or Pistachios

Turkey and Cheese Roll-up

Half a Whole-Wheat Pita and One-Quarter Cup of Hummus

Zucchini Lasagna

Almost 30 grams of protein PER serving, and this veggie lasagna makes GREAT leftovers. It is low in carbohydrates, lower in calories, and very high in protein. Instead of noodles…you use zucchini!  You won’t even miss the noodles, which can make this a great option for those who need gluten free meal options.

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Ingredients:

2 cups shredded chicken breast (you could also use lean ground turkey or lean ground beef)

1/4 cup chopped onion

2 cup tomato sauce (or favorite spaghetti sauce)

1/2 teaspoon salt

1/2 teaspoon oregano

1/2 teaspoon basil

1/4 teaspoon black pepper

4 medium zucchini (1-1/4 pounds) sliced thinly in long slices.

1 cup low fat cottage cheese

1 egg

3 tablespoons whole wheat flour

1 cup (4 oz.) shredded mozzarella cheese

Directions:

Bring a pot of water to a boil. Cut your zucchini into thin slices the length of the zucchini. These will act as your noodles. Boil zucchini for 3 mins and then lay out on paper towel with another paper towel on top to absorb the excess water. While these are drying make sauce.

In large skillet sprayed thoroughly with cooking spray, combine cooked shredded chicken and your onion over medium heat. Once onion is sauteed, add tomato sauce and seasonings. Bring to boil; reduce heat to simmer, uncovered, for approximately 5 minutes.

While your sauce is cooking, combine in a small bowl; cottage cheese and egg. In a 9×13 baking dish sprayed with cooking spray, place half of the zucchini; sprinkle with half of flour. Top with cottage cheese mixture and half of your chicken/sauce mixture. Repeat layer of zucchini and flour.Sprinkle with mozzarella cheese and remaining meat/sauce mixture.

Bake at 375° for 40 minutes or until heated through. Sprinkle with additional cheese if desired. Let stand for 10 minutes before serving.

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Avocado Tahini Yogurt Salad Dressing

I think it may be my very favorite salad dressing ever. It’s so flavorful, and chock full of healthy ingredients, so you don’t have to feel guilty about using extra dressing on your salad with this one.

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Ingredients

1 cup nonfat plain yogurt

2 – 3 teaspoons garlic

2 Tablespoons Tahini

2 Tablespoons lemon juice

1/2 of an avocado

1 teaspoon of sugar

Salt and freshly ground pepper to taste

Directions

Put all ingredients except salt and pepper in a blender or food processor and blend till smooth. Stir in salt and pepper to taste. Chill and serve.

Makes 5 servings

Serving Size: 2 Tbsp

Calories 39

Total Fat 2g.

Saturated Fat 0g.

Cholesterol 3mg.

Sodium 66mg.

Protein 2g.

Carbohydrates 4g.

Fiber 0g.

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Turkey Meatloaf

Turkey meatloaf is one of our favorite make-ahead foods for lunch during the work week.
Seriously, it’s got it all:It’s easy to make in large quantities;  it’s portable and  it’s low-fat, low-carb

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Ingredients

1 teaspoon vegetable oil
4 ounces turkey bacon, chopped
1/2 yellow onion, chopped (1 cup)
1 small green bell pepper, chopped (3/4 cup)
coarse salt and ground pepper
1 garlic clove, minced
3/4 cup rolled oats (not instant)
1 cup evaporated milk
1 1/2 pounds ground turkey (preferably 85% lean) or a blend of ground turkey thighs and breast
1 1/4 cups chili sauce (sweet) or ketchup

Directions

1. Preheat oven to 350 degrees. In a large skillet, heat oil over medium-high. Cook bacon, stirring, until almost crisp, about 4 minutes. Add onion and bell pepper, season to taste with salt and pepper, and cook until vegetables are soft, about 3 minutes. Add garlic and cook 1 minute. Transfer mixture to a large bowl and add oats and evaporated milk. Let cool.

2. Add turkey, 1/2 teaspoon salt, 1/4 teaspoon pepper, and 2 tablespoons chili sauce and stir well to combine. Transfer mixture to a 5-by-9-inch loaf pan and smooth top. Spread remaining chili sauce over top. Bake until meatloaf is cooked through (an instant-read thermometer inserted in center should read 165 degrees), about 1 hour 10 minutes. Let cool in pan 20 minutes before slicing.

Makes 5 – 6 servings

Serving Size: 1 slice (3 oz)

Calories 191

Total Fat 7g.

Saturated Fat 2g.

Cholesterol 103mg.

Sodium 205mg

Protein 23g.

Carbohydrates 9g.

Fiber 1g.

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Chicken and Spanish Rice

Change boring left-over chicken and rice into a quick meal with south of the border flare.

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Ingredients

1 whole chicken cut into pieces

1 cup of rice

2 tbs. of garlic powder

1 can of tomato sauce

1 med onion chopped

4 tabs of cooking oil

2 cup of chicken stock or water

1 tbs. of salt

Directions

Add cooking oil and brown chicken in a large skillet for 15 minutes.

Brown rice in a separate skillet until golden brown.

Add chicken stock and garlic, tomato sauce, onion, salt, and chicken into rice cover and allow to simmer. Simmer on medium heat for 20 minutes. Then serve.

Makes 4 servings

Serving Size: 1 cup

Calories 428

Total Fat 8g.

Saturated Fat 2g.

Cholesterol 20mg.

Sodium 341mg.

Protein 35g.

Carbohydrates 52g.

Fiber 8g.

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Potato Salad

This is not your mothers potato salad. This light version is much lower in fat and over all calories.  You can also add flavor by adding your favorite salad dressing to this basic recipe. The key is to let the flavors set in, before serving.

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Ingredients

16 small new potatoes (5 cups)

2 Tbsp olive oil

1/4 cup green onions, chopped

1/4 tsp black pepper

1 tsp dill weed, dried

Directions

1. Thoroughly clean potatoes with vegetable brush and water.

2. Boil potatoes for 20 minutes or until tender.

3. Drain and cool potatoes for 20 minutes.

4. Cut potatoes into quarters and mix with olive oil, onions, and spices.

5. Refrigerate until ready to serve.

Makes 5 servings

Serving Size: 1 cup

Calories 196

Total Fat 6g.

Saturated Fat 1g.

Cholesterol 0g.

Sodium 17mg.

Protein 4g.

Carbohydrates 34g.

Fiber 4g.

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Smart Start Menu - #4

Eating healthy is probably the most important thing you can do for yourself. Giving your body the nutrients it needs, can help you function at your peak while keeping your weight in check. The problem for many of us is not that we don’t want to eat healthy, but that we don’t always know how to eat healthy. You may know you need more fruits and veggies, but what you really need to know is how to sneak more into your diet.

These Smart Start menus are a good road map to putting it all together. You can follow them exactly or use them as an example and make adjustments according to your taste.

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With just a few items from you kitchen you can whisk up this quick and easy basic Vinaigrette in just minutes. You can experiment by trying different flavored vinegars.
This recipe is used in Smart Start Menu – #2

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Vinaigrette Salad Dressing

Ingredients

1 bulb garlic, separated and peeled

1/2 cup water

1 Tbsp red wine vinegar

1/4 tsp honey

1 Tbsp virgin olive oil

1/4 tsp black pepper

Directions

1. Place the garlic cloves into a small saucepan and pour enough water (about 1/2 cup) to cover them.

2. Bring water to a boil, then reduce heat and simmer until garlic is tender, about 15 minutes.

3. Reduce the liquid to 2 Tbsp and increase the heat for 3 minutes.

4. Pour the contents into a small sieve over a bowl, and with a wooden spoon, mash the garlic through the sieve into the bowl.

5. Whisk the vinegar into the garlic mixture; incorporate the oil and seasoning.

Makes 4 servings

Serving Size: 2 Tbsp Per Serving:

Calories 33

Total Fat 3g.

Saturated Fat 1g.

Cholesterol 0mg.

Sodium 1mg.

Protein 0g.

Carbohydrates 1g.

Spaghetti Sauce

This is a simple basic sauce recipe. You can add your favorite extras to your liking such as lean meat, bell pepper, mushrooms, olives you get the idea. Don’t forget extras mean extra calories.

This recipe is used in Smart Start Recipe – #2

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Ingredients

2 Tbsp olive oil

2 small onions, chopped

3 cloves garlic, chopped

11/4 cups zucchini, sliced

1 Tbsp oregano, dried

1 Tbsp basil, dried

1 8 oz can tomato sauce

1 6 oz can tomato paste*

2 medium tomatoes, chopped

1 cup water

Directions

1. In a med. skillet, heat oil. Sauté onions, garlic and zucchini in oil for 5 min. on medium heat.

2. Add remaining ingredients and simmer covered for 45 minutes. Serve over spaghetti squash or other whole grain pasta.

Makes 6 servings

Serving Size: 3/4 cup
Calories 105
Total Fat 5g.
Saturated Fat 1g.
Cholesterol 0mg.
Sodium 479mg
Protein 3g.
Carbohydrate 15g.
Fiber 4g.

Quick and easy to make with left-over chicken from the night before. Or buy Chicken cooked and cubed at the market. Add this salad as a filling for a  just about anything from flat bread to a beefsteak tomato. Also try add-on like dried fruit, nuts and avocado (don’t forget to count the extra calories)

Chicken Salad

This recipe is featured in Smart Start menu – #1

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31/4 cups chicken breast, cooked, cubed, and skinless

1/4 cup celery, chopped

1 Tbsp lemon juice

1/2 tsp onion powder

1/8 tsp salt*

3 Tbsp mayonnaise, low-fat

1. Bake chicken, cut into cubes, and refrigerate.

2. In a large bowl combine rest of ingredients, add chilled chicken and mix well.

Makes 5 servings

Serving Size: 3/4 cup

Per Serving:

Calories 176

Total Fat 6g.

Saturated Fat 2g.

Cholesterol 77mg.

Sodium 179mg.

Protein 27g.

Carbohydrate 2g.

Fiber 0g.

Smart Start Menu # 7

Eating healthy is probably the most important thing you can do for yourself. Giving your body the nutrients it needs, can help you function at your peak while keeping your weight in check. The problem for many of us is not that we don’t want to eat healthy, but that we don’t always know how to eat healthy. You may know you need more fruits and veggies, but what you really need to know is how to sneak more into your diet.

These Smart Start menus are a good road map to putting it all together. You can follow them exactly or use them as an example and make adjustments according to your taste.

Smart Start Menu #6

Eating healthy is probably the most important thing you can do for yourself. Giving your body the nutrients it needs, can help you function at your peak while keeping your weight in check. The problem for many of us is not that we don’t want to eat healthy, but that we don’t always know how to eat healthy. You may know you need more fruits and veggies, but what you really need to know is how to sneak more into your diet.

These Smart Start menus are a good road map to putting it all together. You can follow them exactly or use them as an example and make adjustments according to your taste.