Enjoying Holiday Meals After Gastric Surgery.

Now that you’ve witnessed the revelry of the costumed candy fiends of Halloween, it’s very clear that the major holidays are upon us. Fear not! While many people’s “one cheat day” somehow turns into a several day binge and sloth cycle, you may enjoy all that the holidays offer without having to suffer or overdo it. Who knows? You may be the only person at the table not lapsing into a miserable food coma after dinner! 

Here are a few tips and tricks to ensure that you are able to stay on your dietary track this holiday season:

• Consume a few glasses of water about an hour or so before you arrive at your event. Drinking water will ensure that you are well hydrated and make you feel just that little bit more full. Avoid drinking much water too close to or during mealtime, however, as this may dilute the stomach’s hydrochloric acid, which is necessary for proper digestion.

• Savor your food in small portions, chewing it well and thoroughly enjoying it. Spend the next 20 to 30 minutes connecting with friends, colleagues or family members at the party. Taking downtime like this allows your body’s fullness trigger to catch up with the amount of food you actually eat.  

• Keep food out of your hands! Practice mindful breathing or find something to keep your hands busy with. If you allow yourself to hold a plate or glass for social comfort, you will likely consume more. Bring your knitting supplies, a deck of cards, or some other conversation starter. Who knows? You may inadvertently inspire others to moderate their eating as well.

• If possible, attend your functions with a friend or support group partner that is on a similar diet. Having others around you eat in a similar way can make it much less daunting.

• Make healthy choices, dessert is off limits. Keep disciplined, sugar is no longer your friend and will only push you back a step.

With this tiny bit of wisdom, you’ll surely be able to the holidays without the guilt or discomfort that you may otherwise be plagued with. Enjoy your food, family and friends to the fullest. If you notice the post-feast nap contingence collapsing before your eyes, take a moment of gratitude for your new life, offering a true thanks-giving to all that is now possible for you.

When is Weight Loss Surgery less risky than doing nothing?

Determining whether it’s the right time to have weight-loss surgery requires the consideration of several factors. Typically, a person who is one-hundred, or more, pounds over their ideal weight and has tried various lifestyle adjustments in order to lose the weight, namely employing exercise and proper nutrition, is considered to be a candidate for bariatric surgery.

It is, however, difficult to determine at what point you are losing the battle and the risk of surgery is greater than the risk of continuing with your current diet regimen. It is key to consider both the risks of both longstanding obesity and those of medical intervention and choose the option that has fewer inherent risks and provide a higher quality of life.

First, let’s have a look at the exhaustive list of health risks associated with having weight-loss surgery according to Mayo Clinic. Keep in mind that most of the risks associated with these surgical procedures are common to most any kind of surgery, and that the longer-term risks are most often associated with a failure to follow the post-surgical dietary guidelines prescribed by the patients’ surgeons and nutritionists, a lifestyle commitment whose importance is emphasized prior to electing for surgery.

As with any major surgery, gastric bypass and other weight-loss surgeries pose potential health risks, both in the short term and long term.

Risks associated with the surgical procedure can include:

·       Excessive bleeding

·       Infection

·       Adverse reactions to anesthesia

·       Blood clots

·       Lung or breathing problems

·       Leaks in your gastrointestinal system

·       Death (rare)

Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

·       Bowel obstruction

·       Dumping syndrome, causing diarrhea, nausea or vomiting

·       Gallstones

·       Hernias

·       Low blood sugar (hypoglycemia)

·       Malnutrition

·       Stomach perforation

·       Ulcers

·       Vomiting

·       Death (rare)

While many of these potential complications are due to the patient’s cooperation in terms of diet and lifestyle, they also depend on the experience and skill of the operating surgeon. You should always find out how many surgeries a doctor has performed, and maybe interview a couple of his or her former patients before advancing to the operating room.

Second, let’s examine some of the many health risks associated with obesity (>30 BMI) and morbid obesity (>40 BMI) according to Mayo Clinic:

If you're obese, you're more likely to develop a number of potentially serious health problems, including:

·       High triglycerides and low high-density lipoprotein (HDL) cholesterol

·       Type 2 diabetes

·       High blood pressure

·       Metabolic syndrome — a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol

·       Heart disease

·       Stroke

·       Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate

·       Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts

·       Gallbladder disease

·       Gynecologic problems, such as infertility and irregular periods

·       Erectile dysfunction and sexual health issues

·       Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring

·       Osteoarthritis

·       Skin conditions, including poor wound healing

Quality of life

When you're obese, your overall quality of life may be lower, too. You may not be able to do things you'd normally enjoy as easily as you'd like, such as participating in enjoyable activities. You may avoid public places. Obese people may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

·       Depression

·       Disability

·       Sexual problems

·       Shame and guilt

·       Social isolation

·       Lower work achievement

As you may surmise, the side effects of being chronically obese are vast and severely affect peoples' quality of life. Some of the more complicated conditions have been medically proven to be reversed 

through bariatric weight-loss surgeries including diabetes, hypertension, high cholesterol and sleep apnea. This being the case, people need to realize that every month that goes by without doing something to reverse this condition is another month of letting these risk factors settle in more fully as likely outcomes rather than mere possibilities.

I require that patients do everything they can in terms of adjusting their lives to include healthy habits prior to going the surgical route. For many people, this just doesn’t work after even the most painstaking efforts. I suppose I could summarize my outlook as this:

Weight loss surgery is only justifiable when the risk to do nothing is greater than the risk to have surgery. At that point, however, it seems not only justifiable but crucial.

Sources:

http://www.mayoclinic.org/tests-procedures/bariatric-surgery/basics/risks/prc-20019138

http://www.mayoclinic.org/diseases-conditions/obesity/basics/complications/con-20014834

Hunger & Cravings...a difference?

There are so many components involved in our relationship with food, and this becomes all too apparent when we decide that it’s time to better manage our eating habits. Often, we realize just how out of control are our urges and habits, whether physiological or psychological, which only adds to our anxiety about our new undertaking. How then does this anxiety affect the process? Is this the making of some vicious cycle of impulsive eating, or is it actually more of a biological issue? These are the questions that loop in the minds of people suffering with obesity and struggling to overcome it. The answer is that both hormonal and thinking processes govern how, what, and why we eat, and that reigning-in any unruly routines is something that must be approached from many angles.

Hunger is, in fact, a very linear bodily function that is initiated from the stomach itself, signaling to the brain that it has been empty for some time and needs to be refilled to ensure the prevention of physical starvation. The hormone whose release is triggered by the empty stomach is called ghrelin, and it then stimulates the release of neuropeptide Y from the hypothalamus of the brain, thereby stimulating the body’s hunger response. When the body begins to receive its nourishment from the intake of food, the fat tissues of the body then release another hormone called leptin, which initiates the brain’s release of its hunger suppressant, proopiomelanocortin (Wright). These hormonal feedback loops, along with the brain’s monitoring of blood-sugar and insulin levels, are meant to guarantee that the body is neither starved nor stuffed.

Cravings, on the other hand, are much more complicated in nature. As we move through life, we collect so many psychological memories and associations, both positive and negative. These memories and associations play a big role in the evolution of our personality and how we relate to our environment. We unconsciously gravitate to those things that remind us of pleasurable experiences while doing our best to avoid or eliminate things that bring painful memories, often unresolved traumas, to the forefront of our minds and feelings. In an attempt to keep the body and mind flooded with a sense of feeling not even necessarily good, but simply okay and well enough to cope with life’s compounding stresses, food cravings develop as a means to distract us from what is uncomfortable and to pacify our negative feelings.

 

While psychological in its onset, this phenomenon is only possible because of how it affects the body on a chemical level. When we give in to our cravings for fatty or sugary foods, our brain chemistry is affected in much the same way as that of a drug abuser or internet-porn addict. Opioids from the hippocampus of the brain are unleashed, which stimulates a general sense of release and euphoria, and this then affects the brain’s internal reward circuitry in such a way that our relationship to the world around us and our sense of reality in general may become distorted (ScienceDaily). Our artificial, temporary feelings of pleasure suggest that everything is suddenly fine, and that we don’t need to face whatever it is that may remain unresolved or insufficiently dealt with.

Over time, this way of coping with the world by regulating our internal feelings with food as a drug can result in confusing what was once a rather cut and dry hunger response, skewing the body’s ability to communicate its nutritional needs with itself in a functional way. Combined with the fact that typical restrictive dieting has proven to be associated with a lowering of serotonin levels, common to people dealing with depression or women in their premenstrual cycle, it’s no wonder that people have difficulty establishing and maintaining healthy ways of relating to food once these unhealthy neural pathways have been laid.

One extremely powerful benefit of gastric surgery for people who have tried dieting without a desirable outcome is that the portion of the stomach that releases the hunger stimulating hormone, ghrelin, is removed in both the Gastric Sleeve and Gastric Bypass surgeries (but not the Lap Band), which thereby decreases the impulse to eat (Langer). Otherwise, due to how we’ve conditioned ourselves to crave the wrong kinds of food in order to get that false rush of pleasure, the body’s natural hunger response could initiate a cascade of food craving impulses making it all the more difficult to maintain a healthy intake of what the body can actually use.

Needless to say, the mental and emotional issues underpinning food cravings and other addictions should still be dealt with in order to clear out whatever traumatic debris may be in the way of our ability to be fully present and functional to whatever we may experience in our day-to-day lives. As needed, this can be facilitated by a myriad of approaches in the mental-health world, a field whose stigma has been considerably lifted in recent decades due to a deepening understanding of the mind-body connection and the undeniably high-stress society in which we live. That withstanding, gastric surgery recipients invariably report that their hunger and preoccupation with food decreases significantly after the procedure, leading to an increase in self-esteem and genuine feelings of well-being that primarily stem from having shed the pounds that have kept them weighed down for so long.

Sources:

·        "Images Of Desire: Brain Regions Activated By Food Craving Overlap With Areas Implicated In Drug  Craving." Monell Chemical Senses Center. ScienceDaily. Nov. 11, 2004. (Aug. 7, 2008)

·         Langer, F., Reza Hoda, M., Bohdjalian, A., Felberbauer, F., Zacherl, J., Wenzl, E., ... Prager, G. (n.d.).  Sleeve Gastrectomy And Gastric Banding: Effects On Plasma Ghrelin Levels.Obesity Surgery, 1024-  1029.

Wright, Karen. "Consuming Passions." Psychology Today. March/April 2008. (Aug. 7, 2008)

Why the Lap Band is No Longer the Favored Option.

When considering gastric surgery for weight loss, one must factor in effectiveness, maintenance, and longevity. Seeing as there are several options available in bariatric surgery, one has to think about what would be most suitable for his or her individual needs and concerns.

There are two main categories of weight-loss surgeries; restrictive and malabsorptive. Restrictive procedures limit the amount of food one can eat by making the stomach smaller, while malabsorptive procedures, such as the Roux-en-Y Gastric Bypass, also reduce the body’s ability to absorb calories by circumventing part of the small intestine (combined with the restrictive intervention). This article will focus on the simpler and more common of the two, restrictive surgeries. These include the Adjustable Gastric Band (Lap Band) and the Vertical Sleeve Gastrectomy (Gastric Sleeve).

Gastric Surgery Options

When the Lap Band was first introduced, it quickly became the go-to solution for people who couldn’t lose weight no matter what they tried to do in terms of diet, exercise, and other lifestyle modifications. It works by reducing the stomach’s volume by placing a ring around it, slowing and limiting the amount of food a patient is able to consume at a time. While its results are undeniable, the test of time has revealed some of its shortcomings.

Regular "Fills"

Firstly, it requires regular tune-ups known as “fills” where liquid is injected into the ring to modulate how much of the stomach is being restricted. This adjustability is sensible in theory, but at the tune of around $200 every month or two, this extra cost takes a considerable bite out of the monthly budget. 

Lap Band Migration

Secondly, while the band’s biggest supporters laud its non-invasiveness, it is a foreign body that is not always as sturdy as one would hope. Many patients have had to undergo revision surgery due to its unintended slippage (migration). Any time a second surgery becomes necessary on the same site, it becomes a more invasive procedure.

The Gastric Sleeve surgery, on the other hand, has become the new favorite, and will likely keep that title for the long haul. It limits the amount of food one can consume, much like the Lap Band, but once it is set into place there are no adjustments or maintenance measures with which to be concerned. Rather than placing a ring around the organ, a portion of its volume is simply removed and the stomach stapled together, never needing to be altered again. In addition, the portion removed includes the gland that secretes grehlin, a hunger stimulant, which makes eating sensible portions much easier and more satisfying.

An astoundingly positive set of side-effects of both surgeries includes the reversal of several co-morbidities such as high cholesterol, hypertension, type-II diabetes, and sleep apnea. The Gastric Sleeve, however, is more effective on all counts.

Support Following Weight Loss Surgery

You’ve had weight loss surgery, now the work begins. Here are some tips to help you find support.

While weight-loss surgery affords a newfound freedom to people seeking a final solution to obesity, it comes with its own unique set of responsibilities and challenges for which patients will want to be prepared. Namely, being required to observe a dietary lifestyle that's in accord with your new anatomy is a discipline that may not immediately register for those with whom you share meals, and it's important that you feel a solid sense of support during this transitional period into the new life you're claiming for yourself.

Because of your restricted food intake and inability to absorb as many calories, it's vital that you stay on top of your diet and make sure you are consistently getting all the essential nutrition that your body truly needs. This plan is initially set-up with your surgeon and dietician when you undergo your weight-loss procedure*, but you may also find it helpful to consult with a local nutritionist when you get home...someone with whom you can track your experience, make whatever subtle changes may help you stay most in-tune, and to help keep yourself accountable until your new habit patterns become seamlessly integrated into your life's rhythm.

Fear not! Even if it sometimes seems like everybody around you is consuming food no longer in your diet and you feel alone or unsupported, there are a lot of amazing people like yourself who are taking it in stride and are readily available for sharing, reflection, mutual celebration and assistance. Here are just a few of the many resources available to help you embrace and nourish your new way of healthy living!

Post-Bariatric Surgery Support Forums:

http://www.bariatricpal.com

http://www.3fatchicks.com/forum/

ttp://www.thinnertimesforum.com

http://www.obesityhelp.com

*And remember, the MedToGo team and your personal surgeon are always available as a resource for more information. Each doctor has a dietician on their staff who is available by email or phone for post-op advice.