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Sunday, April 7, 2013

Emotions After weight Loss Surgery

Many people find that the first few months after surgery can be very emotional for them.  Many books and websites fail to mention this and so, after explaining it to many people, I decided to do a post on it.   I find that when people understand what is going on it is less overwhelming to them.  There are a few reasons for some people being highly emotional after surgery and here are just a few:

First off, for most of us, the journey to surgery has been a very long road.  A very emotional road no less.  It's like we spend months and months working towards this goal of surgery with the preop diet, the lifestyle changes, Optifast and the like.  It's a constantly build up and sometimes flood of emotions. It hits us to the core in so many respects.  Once we have surgery, often there's the sense of "What now?".  It is not that we expect to really wake up thin but sometimes our brain works this way that we are subsconsiciously expect this big post op change and really for most of us, the days preceeding surgery do not have a lot of change with our weight, our size and our body image.  It takes a while before we start to look different, before we start to feel different and before the payoffs of surgery start happening.  So we often wonder or question "is that all there is?" and "what now?".  Pretty common and typical response.  Many of us feel no different and wonder if truly we've been operated on.

Others, can be overwhelmed by the change with their relationship with food.  Food is no longer a quick solution to an emotional problem.  For most of us, it is no longer pleasurable and quite frankly, for many of us the pleasure of food is a huge key aspect with our relationship to it.   Eating is not pleasurable for may of us.  It's labourous at best with the amount of chewing, the restrictions, the sometimes vomiting, etc.  So this is a very different feeling for us.  There's no more pleasure in eating and that's a big issue for many of us until we start to reframe our brain that it is a good thing because we now have power over food.  Many, many new post ops, miss food, miss the sensations, miss the taste and go into a mourning period.  The trick at this time is to remember that this is a HUGE step in redefining your relationship with food for the better.  You are no longer living to eat, you are now eating to live.  If you are not hungry, embrace it and eat to fuel your body nutritionally and to reduce the "crap" in your diet.  Eat clean, get faster results and get off the weight quicker. It's a good thing once you learn to retrain your brain on this!

Another issue with food can be the fact that it is around us.  It is hard to avoid and hard to resist.  People may find social situations tricky for a while.  I tell people it is not uncommon to "take a break" from social situations that involve food....and if that's what you have to do, to stay on program, then really you need to do it for you!  Going to birthdays may be a tricky thing.  It may put you in a position that you are resentful of others, that you are tempted to cheat etc.  It's okay to give yourself a break.  For others, it's not a problem.  I went to a barbecue 2 weeks post op, and sucked my shakes down happily thinking the whole time how powerful it was to resist. It's whatever works for you!

Here's the thing as well - as you are losing, your hormones are also all over the place.  Some hormones are stored in fat. As you reduce the size of your fat cells, these hormones can be released in amounts higher than you're used to. This can cause mood swings for some people and can be really odd and difficult.   Some people find that they are just more over emotional and cry at the drop of the hat while others find that they are a bit more snippy to people around them.  Others are unaffected.  Depending on your age and how much it's disrupting your life, you might want to see your doctor if it becomes unbearable.  

One more key item to mention is for those of you who may be on medications for conditions such as depression.  With your newfound malabsorption with RNY, your meds may not be absorbed properly.  This is very, very common.  Make sure that they are not time-released meds too.  It's a good idea to talk to your doctor or psychiatrists as you may need an alternate form of meds or an increase in dosage since you may not be absorbing your medication completely anymore.  Whatever you do, do not take yourself off depression meds after surgery thinking that your depression will be cured with "losing weight".  That can be a very dangerous assumption.  The rate of suicide is higher for those that have had gastric surgery and this is one possible reason that has been speculated upon.  Make sure you have a friend to keep you in check with your moods.  

Typically, people who do become emotional as a new post op, find that a few months in, things start to calm down as life resumes more normally, as the new diet changes and routines are in place and when they see the pounds start to drop.  If you are having trouble with your emotions, contact your doctor.  If you are just noticing the changes, be patient and know that it WILL get better! Seek professional help when you need it.  This is a big challenge for many and give yourself any supports that you need. Good luck!

Protein For RNY Folks

I get really frustated when I read about protein shakes and wls people that are drinking protein shakes of poor quality after surgery.  Unfortunately, many people think that a protein shake is a protein shake is a protein shake.  This is not true.  There are protein shakes that are better than others, provide us more digestible protein and are a good bang for the buck.  Why would you settle on a crappy inferior protein shake that you may not be absorbing properly, that is more calories and sugar than you need and could impede your weight loss? I don't understand it sometimes.  I find that even many nutritionists give poor recommendations for weight loss folks.

The reason for taking protein shakes is because we want to preserve muscle mass as much as we can while losing.  Consuming adequate protein in your diet will help you maintain muscle mass and heal as you lose weight. It can take up to 6 months for all parts to heal properly.  Long term, you may find that protein is essential because protein helps you lose weight, whereas too many carbs in your diet tend to slow weight down.  As a long timer, I can tell you that to lose weight, I tend to need double the protein in my diet to carbs to lose.

Form is Important

The recommendations for protein shakes and powders ideally that they are WHEY PROTEIN ISOLATE OR CONCENTRATE based.  These are two forms that we absorb well and are high quality proteins.   They are the best of both worlds with isolate being the top one.  As a result, you will find that powders that use isolate will indeed be more expensive.  It's a purer, cleaner form of protein.

The higher the PDCAAS score the better the quality.    The higher the price does not neccessarily mean the higher the quality (although I have found that the ones that taste best are pricier.)

Roughly (although there are lots more protein choices):

Collagen      PDCAAS:  0.08 

Soy              PDCAAS:  1.0

Milk Protein  PDCAAS:  1.0

Casein          PDCAAS:  1.0

Whey Protein PDCAAS: 1.0
You will see many, many people using the protein "shots" or "tubes" but those are made with a blend of different proteins, most of which is cheap collagen protein which as you can see above has a very poor rating. Even many programs do not have nutritionists that know this which is sad. You'll also see some bariatric sites selling this crap.  Why? Money. It's cheap to make and it's cheap to market and sell.  More profit for everyone which I find is just wrong!

Bioavailablity is Important too!

Another reason for whey isolate is because it is not only good quality, but it is digestible for us.  Some types of protein, like collagen cannot be absorbed well either.

Many programs also say no casein protein because of the higher calories.

Look at the Breakdown of Protein/Fats/Carbs

For the best stats of a shake you typically want isolate or concentrate and the following:

Typically you want around 150-200 calories in 30 grams scoop or a 400-500 ml serving.
You want AT LEAST 20 grams of protein.
You want no more than 5 grams of sugar/carbs. Look at BOTH of these numbers.  Carbs turn into sugar.  No more than 5 grams.

These carb/sugar numbers change the breakdown of protein and carbs in your shake. The more percentage of protein, the better your shake.  I personally won't do less than 70% protein or more than 20% carbs.  The lower the percentage of carbs, the better.

Here are some popular shakes: (using chocolate flavour).  This is their ratio of protein/fat/carbs.

Premier Protein.         72% protein, 16% fat and 12% carbs.
Muscle Milk Light.     53% protein, 24% fat and 23% carbs.
Pure Protein               85% protein, 5%  fat and 10% carbs.
Shakeology                44% protein, 12% fat and 44% carbs.  
Profit (Itworks)          59% protein, 13% fat and 28% carbs.
Body Fortress Isol.    80% protein, 14% fat and  6% carbs.
Body By Vi               56% protein, 11% fat and 33% carbs.

*** if you have a protein shake, you'd like me to add to this list - just message me at

Watch the Add-Ins Too!!!

The other issue that seems to crop up are the add-ins.  Once you start adding too much into your protein shake, then the less of a "pure" protein shake it becomes.  Then you start to change the nature of your shake to more of a 'carb and protein' shake.

For example, let's take a commonly used protein powder.  In this case, 1 scoop of Body Fortress - Super Advanced Whey Isolate, Chocolate.   Make that with water and ice and this shake is:  80% protein, 14% fat and 6% carbs.   That is pretty awesome.  You want the bulk of your shake to be protein.   140 calories.

Now add, a cup of skim milk and the stats change to:  64% protein, 10% fat, and 26% carbs.  226 calories.  (Hmm...notice how the carbs are going up).

Add a half a banana to this and it changes even more:   52% protein, 8% fat and 40% carbs.  279 calories.

So although you are indeed getting the SAME amount of protein, you are getting far more carbs than you need and far more calories.  Personally my cut off is no less than 70% protein.

Although some people will say that they are still losing, they will still lose on those...but can they slow down your losing? Yes and you wouldn't even know it.

Oh and if you have to add in MORE PROTEIN to your protein shake there is something wrong with this picture.  Get a good quality one that has enough protein in it to begin with without having to add milk!  Water and ice should make a good protein shake alone.  But if you can't handle it, find a powder that has a lot of protein in it alone and try almond milk which will change the composition of your shake only minimally.

You will find a lot of "sellers" of protein through various MLM companies like Shakeology, Body by Vi and Itworks.  They will tell you that it "worked" for them but quite frankly, they are making money by selling them to you, so I doubt that they would tell you anything negative about their product. 

As well, do not count on any of the "supplement" or "vitamin" facts for any shake or powder.  DO NOT STOP TAKING YOUR VITAMINS.  The supplement industry is not tightly regulated.  Do not count on these for your vitamin needs.