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 diminishingdawn@cogeco.ca
      

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. 

6 Years Post Op: The Good, The Bad and The Ugly

Well it's time for that post – six years since I've had surgery and time to be grateful for my journey, the friends I've made and the things I've learned about me. This is going to be a long post. I'm wordy – I admit it. I thought I'd give you an overview of my victories and my challenges along my journey. I imagine that some people will not take the time to read such a long post, but I put it out there for those that want an idea of what one person's struggles are post op after six years in the journey. I have to say that this journey does not stop when one gets to goal. It truly is a life long journey. Don't rush it. It's going to be there for the rest of your life.

I'm hoping this post won't come across as too negative and whiney...but it just might. I want people to know that there are not always rainbows and unicorns in our journey. There are issues of all kinds after surgery and after you've been out a while.

I had surgery on July 5^th, 2006. Back then many of us went to Michigan My care there was great, after care really sucked. But my surgeon was wonderful and I had very few problems with my surgery itself. The only complication was a nicked artery. I lost a bit more blood than most patients but recovery was fairly easy. I was at the mall my second day home. It truly was easy breezy!

My first year out was GLORIOUS. I have no other word to describe it. It was so wonderful. Although I was a slow loser (my surgical centre gave us no guidelines on carbs and I do think that slowed me down compared to others) I did fairly well. I started at 290 lbs before surgery and ended up being less than half that by goal. My first year I followed the rules very well and made exercise a huge part of my life. I made a point of walking to and home from work every day 3 miles and then would jump on my treadmill at home for another 4 miles. I was pretty motivated, highly focused and felt so strong and powerful. I remember feeling so strong and powerful – I was now eating to live and not living to eat. I loved feeling that power over food! The first year is a CONSTANT high. We long timers wish we could bottle it and have it back. LOL It's purely magical!

Early deficiency of iron and osteopenia developed by the year mark. Started supplementing.

The second year was pretty good too. I still had that high...but the binges started to creep in now and again. Those of us who are binge eaters do tend to struggle post op. I'd binge and then cry about the binge. I hated myself for doing it. I was even planning binges in advance...and then feeling like a failure a half hour later when I felt like crap. I started to gain. It started to freak me out to be honest. Five pounds up. Feeling a bit daunted. People actually commented that I was too gaunt earlier and that I was looking better...but I did not feel that at all. The mental struggle was beginning and the feelings of being out of control and feelings of failure were terribly powerful. I was starting to feel powerless to food, no longer so powerful.

When I got to goal, no one really taught me what it meant to eat in moderation. I'd always been overweight. I always had a problem with food. I was never that person that could eat a small bag of chips and put half of it away for later. Not even as a teenager. It was a foreign concept. Portion sizes were starting to get larger. It started to get scary. I could eat more and binges were bigger. It was getting downright scary. Feeling out of control, feeling worthless.....up 10 lbs...

I ended up as a size 10. I was devastated. People I worked with were size 0 and 2 after having children. I started to obsess and do the 5 day pouch test....then cut carbs completely, then bingeing. I'd repeat the cycle again and again only to have the same results. I'd work hard for a week and lose only 1 lb but then binge on a bad weekend and gain double that. The weight was no longer falling off like it once did. I felt like 10 lbs could have been 100. I know it sounds strange but that 10 lbs was totally overwhelming to me.

I started feeling like a failure because I didn't get to size 4 or 6. I was still “big”. I felt like a failure. I know that it seems so foreign that you'd consider yourself a failure being a size 10 or size 12 after being size 26/28 at your heaviest...but the mind is a strange thing. I became too obsessed with comparing myself to others. Not realizing how far I'd come. The reality is that some of us have bigger frames, some of us will be a size 2, some will be a size 10 or a size 18 or any size really. We are all so different. Again, the worst thing you can do is to compare yourself to others.

I decided I had better get into therapy. I went to our local eating disorder place for 6 months of therapy. They cater to binge eaters, over eaters, bullemics and anorexics. I learned a lot about Cognitive Behavioural Therapy which many of us benefit from post op to deal with the head issues. I learned to try not to base my happiness on a size or number on a scale. I'm still not ready to throw out my scale like they suggest. A funny thing happened at therapy though – I also became obsessed with how skinny the anorexics look so while I made some progress, I think head issues were still skewed. Again head issues are a strange thing post op. More issues with anemia.

Year 2 was also when I discovered that I had Reactive Hypoglycemia. I never had diabetes or had issues with blood sugar so that required a lot of reading and learning on something new. I diagnosed myself, took the information to my doctor and yes, it was confirmed. I managed it fairly well. Sugar is the enemy. I wish I didn't have an issue with sugar – that I could keep it out of my life completely but sugar is my struggle always. Managed the RH fairly well this year. No problems with it other than a few lows.

Years 3 and 4, I continued the same skewed thinking while creeping up and up on the scale. I had a lot of issues going on in my personal life that lead to a lot of emotional eating. At one point, I ended up 27 lbs above my goal. I kid you not. SOOOO easy to do when your mind is skewed. I struggled. I had a few comments said to me that made me feel like giving up and running away. I would battle dark days of hating me, hating the scale and feeling like a total failure. It's very hard to run a support group for weight loss when you are going through the issues but I continued to do it. It was embarrassing to be up at the front when you were feeling like a failure. I lurked more on OH, poking my head in now and again, but feeling like a lost puppy. Didn't really fit in with the “rah rah” of the newbies and feeling like I couldn't offer any thing to anyone when I was struggling with myself. Up to size 12 and then closer to a 14.

Year 5 was better. Feeling like I started to make peace with my bounceback. Do I like it? No. But I managed to get off around 15 lbs of it and felt more in control. Still working on the self image and positive talk but feeling more like I'm a survivor in this thing called WLS rather than a failure. Realizing that I'm not the only person that struggles. I'm not alone in this journey. Back to size 12 but still working towards 10.

So here I stand at year 6, feeling more at peace. Again still a work in progress but trying to like myself more. In my head, I am still big and still relate to the large people in the room than the “skinny minnies”. Constantly have the feeling that I'm still a size 26. Regain is all in my stomach and butt and makes me feel constantly bloated and feeling like I look pregnant. I never feel like clothes fit like they did when I got to goal. I can tell that my body composition has changed with regain. Lost a lot of muscle mass. More wobbly bits than before.

This year again, anemia is still kicking its ugly head. Some low vitamin d for the first time. RH is kicking my butt more this year than ever before. I've had two issues in the past 6 months of passing out from it. (One time I put off symptoms when I shouldn't have – the second one, I attributed the symptoms to being sick from the heat versus RH). That's been scary but both times I really should have known better.

Food issues are still there. I call it my FAT HEAD. I am constantly struggling with my fat head – emotional eating, boredom eating, stress eating and bingeing. It's a constant struggle not to give in and sometimes I do. I am one of the few that can honestly eat anything. There is nothing that disagrees with my pouch – nothing. And I can eat large amounts. It would scare most people how much I can eat. To this day, I've still never vomited once, had things stuck or had the foamies.

I've learned that I have to just keep picking myself up and dusting myself off and set new goals. I'm a work in progress – for the rest of my life. Surgery did not fix my head in any respect.

I still have around 10-12 of regain to get back off. I'm starting to make peace with that though. It's not the end of the world if I stay where I am at. I'm starting to strongly believe the issue of set point. My body is pretty resistant. So I'm trying to make peace with the fact that I may still carry some extra weight with me and that it's not the worst thing in the world if I do. It could be far worse. It could have easily slipped to 40, 50 pounds had I not caught it earlier when it started to spiral. Some days I feel in control of my eating and other days I still feel overwhelmed. For me, it's day to day...one day at a time.

I'm grateful for many things:

Other than the RH issues, I'm healthy. Anemic still but no other problems. Healthy is a good thing. I'm strong. I'm mobile. I'm active. Life doesn't pass me by unless I want it to. I've coached swimming, baseball, basketball. I've done walked three half marathons in Detroit. I've met many nice people in the WLS community. Running a support group has helped me be accountable to myself and others. I cannot put my head in the sand and ignore the creeping weight. I need the support group as much as others.

I see my parents struggling with their obesity and I'm so glad that I made the choice that I did to have surgery. Both of my parents can barely walk a block without being terribly winded, my Mom is at the point that soon she'll need a cane or a scooter. I'm not there. I'm not going to have a heart attack at a young age like my mother did. I still have my life and quality of life. It's really a wonderful thing.

My goal is to keep working on the head issues. I highly encourage newbies to examine these issues before surgery. The head stuff can be brutal for many of us. You will see me on this board talking about regain/bounceback quite frankly. I think we need to start taking the shame out of it. It happens and most surgeons do expect it. I think by beating ourselves up we are not doing ourselves any favours. I wish people had given me more of a heads up on it to be honest. Then maybe it wouldn't have been so devastating to me.

Anyway, there's the good, bad and ugly of my surgery and my life post op. I know that my experiences are not the same as everyone else's but I'm sure I'm also not the only one to go through such a range of emotional issues and head issues after surgery. So I thought I'd put this out there for anyone who may relate to my story or anyone that wants to chat about any of these issues. Sometimes feeling like we are not alone in this journey is a very powerful thing.

Newbies: WLS is an absolutely amazing gift. It's a wonderful gift but also a big responsibility to use it wisely and there may be many times that you struggle along this journey. Please don't waste the wonderful gift you've been given. Get to goal your first year, keep your triggers at bay and work towards getting off the most weight you can while you can. Despite the head struggles, I would still do surgery all over again. It's truly a wonderful gift!

Have a good day,

Dawn

Medic Alert Bracelets

After surgery, it is quite common for the WLS community members to rush out and get a medic alert bracelet.  I was told that this was a must for any RNYer shortly after surgery. Even surgeons still recommend them. Many facilities are now staying NO to medic alerts - at least to putting a lot of information on them and rightly so.  Many facilities are finding that the messages written on them are now causing more problems with hospital treatment rather then helping.

I encourage you to really give the purchase of a medic alert bracelet some good thought.  Think about each thing you choose to put on it and what the benefits (and risks) could be.  Rather than go blindly by common statements that people will tell you to put on them, please consider all the aspects of what you put on the bracelet.  Today's post is going to take some of the common statements put on bracelets and explain why they can be a good and bad thing.  I've read this on various boards, talk to some medical personnel and heard some of the following information.  I admit I blindly went out and bought mine just based on what others told me to do.   Ultimately the decision is up to you, but I thought I would at least share what I've learned over the years that has changed my mind on the whole medic alert issue..  

Remember that medic alert bracelets are for times of unconciousness - when you cannot speak for yourself.  They are designed for FIRST RESPONDERS - paramedics.  Realistically, most of the time when we do go to the hospital - even those of us who had RNY and have complications come up, we are totally capable of speaking when we go in.  Those of us who do go in to the hospital often have caregivers that do the speaking for us.   A well educated colleague, spouse or family member will go much further than having a bracelet speak for us.

So here's the top message that typically RNYers put on their bracelets:

No blind NG tube
RNY Gastric bypass
my surgeons name
ICE phone #
no NSAIDS and no sugar

So let me take the time to explain WHY these messages can cause more harm than good.

First of all, if you are going to get a bracelet be sure to put your surgery type and date on them.  Not simply "gastric bypass". It is called a Roux En Y.  (Not RYN as I see so often!).  Putting your surgeon and your surgery date might help although chances are he's not going to remember you much unless you are fresh out of surgery.  But it is never a bad thing if your surgeon talks to anyone and explains the surgery to them.  That's always a bonus.   

As for NG tubes:  They are inserted in patients immediately after major surgery to help keep the stomach empty and prevent postop vomiting and used to feed and administer meds in critically ill patients. In addition, nasogastric tubes are routinely used to collect gastric contents for lab analysis and to aspirate the gut in case of a GI bleed or a drug overdose. The chances of you needing a NG tube are pretty slim but it may be necessary. There's a myth that when put into you, the medical personnel will push and push the tube through and burst your pouch.  That is untrue.  Medical personnel are trained that when they feel resistance of any kind, they stop. 

The ICE information is always good - in case of emergency call.....

But here's the other thing I see put so many times on RNYer's bracelets that scares me - no aspirin or no NSAIDS. While it is true indeed that we should not be on them long term, there may come a time when I will gladly open my arms to aspirin!  If I were to have a heart attack, PLEASE PLEASE give me aspirin!!

Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die — and it’s a heart attack. Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence.

Since my own mother had a massive heart attack at age 59, I definitely will risk an ulcer in order to treat a heart attack!!  Remember, it's generally a long term use (2 weeks or more) that NSAIDS cause ulcers.

Here's another BIG issue that I want to bring up.  The no sugars statement really seems pretty harmless doesn't it? Not so. It could be dangerous.  It is a common side effect for many of us after our first or second year post op, to develop reactive hypoglycemia .  It's been quoted from 1/4 of us to 3/4 of us will get RH.  When you have RH, you bottom out in your sugars and get extremely low. Dangerously low. Guess what you need? Yep, sugars.   You need to raise your sugar up back to a healthy level.  It is much like people with diabetes having a low.  We can appear drunk, wobbly when moving around and having a low.  Like diabetics we can become unconsciousness.  If I were at the mall and someone noticed this and I started to pass out and they perhaps recognized the signs as being low sugar and were going to treat me, I'd hate for them to look at that bracelet and see "no sugars" and not treat me.   Is sugar going to kill me? No.  Could not getting sugar kill me? It potentially could.

The thing is that first responders aren't generally going to start giving you food and start feeding you sweet tarts.  They are not going to make a point of feeding you - that's what happens at the hospital and that's not til you are stable and they've figured out the medical problem.  That's when your family member would tell them about your restricted diet -- or quiet honestly, you will because you'll be conscious by the time the ordering menu comes around and you need to place a meal. No one is going to start feeding you sweet tarts, apple pie or hot fudge sundaes in an emergency situation.  

So give these aspects some thought before you decide what you'll put on your bracelet if you even decide to buy one.  Sometimes like they say, less is more.

Oh and do I wear my bracelet? No.  It sits in my jewellery box.

Dawn

June Meeting 2012

Last night, at the support group meeting, Carrie and I shared information about a few interesting things in regards to hunger.  We started off the meeting by talking to a newbie who has no hunger (it's such a wonderful thing when it's turned off for so many of us at the beginning) and then we made a list of all the foods that people crave.

We went through the list and noticed something, by and large, practically all the cravings from nachos to pizza, from chips to cookies (and even vodka and beer) all revolved around carbs.  The only exception I believe was coffee.  By and large, we crave carbs.  There is a reason why.  We knew carbs would be a high part of the cravings.

When we have sugar, our body gets a "high", it's like a high to our brain.  When we are tired or very hungry, our bodies CRAVE sugar.  Sugar is a form of "instant" energy and our bodies know that. When we are physically hungry, it is often because our blood sugar is low.  When we ingest the sugar, the sugars make us spike up in blood sugar and often come crashing down to the point that they go even lower - hence we are hungrier even MORE than before.  So what does our body crave?

Yep you named it - more sugar.

Now sugar can be in it's simplest form - like glucose - the candy, cookies, chips - again, instant energy.  But it can also be carbs.  Carbs that are ingested are either turned into sugar and sent to the body or stored.  The more that we eat, the more carbs the body doesn't need for energy, therefore, it's sent to the cells for storage.  Therefore, our fat stores, get...well...fatter.  The sugar is sent to the cells for storage and the cell gets bigger.

So we went over a few simple things we can do:

1) Make sure that when you get sugar (whatever form but especially simple carbs, simple sugars) that you pair the sugar with a protein.  It will helps slow down the digestive process and will help to stabilize blood sugar.  Protein has very little effect on blood sugar alone. 

2)  Eat protein at EVERY meal and snack as much as you can. Our bariatric centre says this all the time: balance, balance - 3 food groups at meals, and 2 food groups at snacks. Remember the best calculation: a diet consisting of 40% (or more) protein, 30% (or less) carbs, and 30% (or less) fat.  The more protein, the better the loss.

3) Look for whole grain carbs - especially with the kernels intact.  Complex carbohydrates are good.  Look for lots of fibre.  Some products we highlighted were:  La Tortilla Factory tortillas (Schwabs, Remark), Joseph's Flax Pitas (Remark). That have very little carbs especially when you figure out the fibre.  We also showed a product called "Shiritaki Noodles" (Metro) which are a soy alternative to regular pasta (rinse well) and Carbmaster Yogurt from Kroger (very little carbs, lots of protein).

4) Shop from the outside of the supermarket as much as possible.  The stuff on the insides is all highly processed and will spike blood sugars.  Look at the glycemic index of foods.  It gives you an idea of some foods that will spike blood sugar (high glycemic) or lower/regulate blood sugar (low glycemic foods).  The worst offenders are usually: white breads, rice, white pasta...etc.  The body processes starch almost as fast as it processes glucose (sugar from say, candy).  If you cook pasta, cook it "al dente" - the mushier it is, the more it will spike your sugars.  The more ripe the fruit as well.  Fresh fruit is better than juice or dried fruit (which has sugar added to it generally) because it has fibre.  Fibre slows down digestion.

5) Want to lose faster or are you losing slower?  Watch the carbs. (I wish I would have known this during my surgery as I'm sure this is one reason I lost slowly).  The more carbs in your diet, the more your body doesn't need them, therefore they are stored.

6) Watch drinks. Many drinks may have virtually any calories...but may be full of carbs.  Again, carbs are broken down to sugars if not needed by the body. Find a protein shake that is water based and low carb (2 grams of sugar or other) and that's even better.

7)  Add acid foods - lemon, lime, vinegar, pickles, mustard - all slow down the blood sugar response.

8) Say yes to fibre and favour the good fats.

Here's the interesting about WLS and hunger:  Initially when you have your surgery (Think a few weeks out), your ghrelin hormone (hunger) is greatly reduced in your body so most people experience very little physical hunger.   This changes especially at 6 months out or more and here's why:   A study from 2011 discovered that the physical reaction (spike in blood sugars as our body pumps out insulin to deal with the sugar in our body) changes from surgery to the 6th month after WLS.

At 6 months out (or so), the physical blood sugar reaction is 3X stronger or more powerful at 6 months out for those who have had the vertical sleeve.  That means that your body pumps out more insulin, and your blood sugar spikes and comes back down.  When it comes down, you may be hungrier than before.  Sugar has a very strong effect.  More sugar = more hunger...so what do you take in? More sugar...and so the ugly, vicious cycle continues.

If you had an RNY, the response in sugar is 20X greater at 6 months out.

Have hunger? Hungry an hour or so after eating?  Find the hunger increasing?  Time to work on stablizing your blood sugar as possible.  Stable blood sugar is the key to getting the hunger monster under control.  

By the way, the Bariatric Centre has seen a lot of people struggling at the 6 month mark with hunger, cravings, emotional eating and the like.  They have moved their 9 month social work group class up to the 6 month mark.  Hunger *is* going to be back.  While you don't have it, use that super power to say NO to the stuff you just don't need.  It's a wonderful time when you don't have the all consuming hunger and although it's hard to eat initially and can be a challenge early out, the new relationship you have with food when you aren't as hungry, is really a wonderful thing.  When hunger comes back, so many of us struggle.  That's when you may need the support group even more.

As well, so many of us have to start watching out for signs of reactive hypoglycemia.  So many of us after RNY get it around the first year mark or so.   Read about Reactive Hypoglycemia here.

Please don't hesitate to email Carrie or I should you need information on products, information or if you have a question.

Dawn

This week I had the good fortune of talking to some people in my group and recommending a program called myfitnesspal.

If you haven't heard of it, it's an online site much like sparkpeople, fitday or dailyplate where you can track your calorie intake and the like to examine what you are eating. When I talk to someone who is stalling or not losing as they'd like, 9 times out of 10 it is the carbs that they've added back into their diets that is slowing down their progress. Numerous times, it's been people that have been doing protein shakes like Body By Vi that are not low carb.

Low carb is a key to weight loss. It doesn't mean going NO CARB.

When you have an eating disorder, the worst thing you can do is to compound the eating disorder by elimating a food group completely. Your body also needs some carbs and there are nutritional values to carbs as well. (Read the China Study about how all plant diets can do wonders for many medical conditions and you'll understand that life with carbs in our body is a good thing in many respects).

Anyway, low carb is important. Most of us did not get fat by eating too much protein. It's usually the processed junk that gets in the way for most of us whether sweets (cakes, cookies, and the like)or crackers, chips, pasta, breads, cereals, popcorn etc. You'll find often that when you stall it's because you've been slowly adding more and more protein to the diet.

The ideal diet for a post RNY/VSG patient is considered to be 40% protein, 30% carbs and 30% fats. Myfitness pal has a WONDERFUL display on their phone app (not on website and not for blackberry users) where you can click a button and see a pie graph that shows you this percentage breakdown. If you go to "home" and click "daily" - there's a little basketball type looking button - that's it.

This is the brillant tool that I've shared with two people this week who both took the time to send me emails/notes and say it totally shows them that they are getting way too many percentages of carbs. One even wrote that she's been following it and already losing weight from it. She's got hope finally as to why she's been gaining, rather than losing.

This is the tool that I'm currently using myself....as my diet can easily go the way of too many carbs. I've even started doing protein shakes - damn the Premier Protein is pretty darn good =) to see if bumping that up helps me out. I'll keep you tuned! Dawn

Spring is on its way!

Here's a dress shot. LOL I'm getting totally in the mood for spring - but that means, getting off the next 12 lbs of regain to get back to goal. Here I am trying on a cute little dress at Marks Work Wearhouse (yes, they have nice clothes and aren't just work overalls and boots). I didn't end up buying the dress...but the dress does symbolize one goal that I am working on.

I am trying to embrace my inner girliness.

It's ironic that when I was 288 lbs I spent a lot of time in dresses. For some reason, when I was larger I felt like dresses were a great thing - they helped hide my rolls and made me feel pretty despite my size. But once I started to lose weight, I didn't buy a single dress. Funny as you'd think it would work in reverse but this goes back to one aspect of my weight loss. The more I lost, the more critical I became of my body. I think that may sound foreign to people as you'd expect that the weight loss would equal more confidence, not less. But that is how it worked for me especially over the long term.

The first year I was on a perpetual high of feeling great. When I started battling my head, fat and weight issues again, that's when the self confidence went down.

So now my plan of attack is to get the 12 more pounds of weight off. I am thinking that spring is a great time as I'll get more active and enjoy the weather. I have all Spring/Summer to s l o w l y make it happen. No fad diets, just slow loss over time is my goal. The other goal of course, is to wear more dresses and skirts and let myself feel girly.

It seemed like a great plan last week when I wore some dresses to school. I think I could have knocked some of my colleagues over with a feather by the way from the looks they gave me seeing me in a dress. LOL But I also got a ton of compliments too. I ended up course wearing the wrong shoes to walk to work and ended up with about 5 blisters and cuts on each foot. So much for my inner girliess! LOL

Dawn