Thoughts on Carbonated Drinks
Scott I,
(since Scott W. mentioned it...)
Carbonation?
I don't know how Coca-Cola is keeping the lights on
Now that they no longer have my usual business.
I used to consume enough to water my lawn with.
Seriously, a 12-pack of Diet Coke each day.
Probably add a few "Big-Gulps" from the 7-11 to that as well!
Now? I have most of a semi-flat Diet coke about once a month.
It gives me a little bit of gas and the Joy is gone for me...
Besides, artificial sweeteners, such as Nutra-Sweet and even Splenda
Have been shown to increase hunger in several studies.
(strange that Diet Soft drinks actually make you More hungry.)
Because it is a "trigger" for continueing old eating habits,
Many Docs have their patients abstain completely.
But because it "Stretches the Pouch?" Not so much, FOR ME....
(your mileage may vary...)
There's some conflicting info out there about-
"Stretching the Pouch" - And - "Stretching the Stoma."
Some of it is complete 'urban legend'
Aimed at explaining why one procedure is 'BETTER' than another.
Typically this information is passed on from someone
Who did not have the procedure they are 'slamming,' and know little other than-
"What I've heard is...."
That's where all of that crap like--
"Most people gain it back..."
"RNY'ers can Never chew gum, eat red meat, or take pills again..."
And such come from.
I've heard-
"Fill up a baggie with coke and seal it up---It'll POP!"
Well, if it had a throat sized opening at the top,
And a small pencil diameter opening in the bottom,
Then it would be a fairly good model for the experiment.
The coke would just run on through the way it does with the pouch.
That said, With a normal stomach
Or one that the procedure leaves the pyloric valve intact, like the DS,
The carbonation stays in the stomach long enough to let some of the fizz
Collect and exit as a normal burp.
With the RNY, a bunch of the carbonation runs on into the intestines
Before "breaking up" or collecting
And the result is extra Poots in the making.
But as to "stretching the pouch?" Only if you can stretch a balloon
By blowing it up with two holes in it.
Stoma stretching Is very possible and can be the result of
"Mal-formation of the stoma" during the original surgical procedure-
(the doc didn't make it the right size to begin with)
And it can be "stretched," usually by forcing it open
1.) Through repetitive weeks of vomiting/muscular contractions,
Or more likely,
2.) continued Over-eating to the point of painfully distending the pouch.
In this case, the patient has "caused" the problem with the tool,
But even then, it still may work to achieve and maintain weight loss.
I'm in no way an expert at all.
I did have A LOT of extra time on my hands
Early on due to complications to do nothing but research and even directly e-mail
Different Bariatric Clinics/Doctors and take part in a lot of
On-Line chats with Bariatric Surgeons.
Many do these, and they are very valuable.
They even sift through posted transcripts for those who missed recent chats such as--
http://www.communitymemorial.com/chat/bariatric_chat.cfm
or-
http://doctorsimpson.com/chattranscripts.php
Many are accessible and the Surgeons are great about answering questions
To those who sign up for their newsletters and such. Like-
http://www.lapsf.com/office-information.php
Having 9 months of "down time" to ask questions,
Got A LOT OF ANSWERS.
So,
The "Stretching" question? ------------
Equally reputable Docs have stated different opinions on it.
Dr. D. Rodriguez, founder of the Texas Bariatric Center, since 1998
Says-
"It is expected and appropriate that the stomach pouch will enlarge somewhat
As the months pass after gastric bypass. Some of this enlargement
Is an actual increase in size, and some represents a softening
(regaining of elasticity) of the pouch and its outlet."
Similarly, Dr. Latham Flanagan, MD -
(website is at The Oregon Center for Bariatric Surgery)
Indicates that the average size of the mature pouch is 5.5 ounces.
He also states that -
"...sizes ranging from 3 to 9 ounces have NO IMPACT
ON THE PERSON'S SUCCESS IN WEIGHT LOSS.
The pouch actually grows rather than stretching as most think.
For most of the patients that have the surgery,
The pouch stops growing at about 6 oz and the largest is about 9 oz."
Compare this to normal stomach sizes between 24 to 64 ounces.
(still, quite the effective TOOL. Yes?)
Flanagan was the one who presented the "Cottage Cheese Test"
To the June 2000 meeting of The American Society for Bariatric Surgery. (ASBS)
Although he had been using it for quite some time.
Although-
Albert Wetter, M.D., of the Mills-Peninsula's Bariatric Surgery Program,
Among the first to participate in the American Society of Bariatric Surgeons'
"Center of Excellence designation process," presents the pouch as "Stretchable."-
According to Wetter-
"It is very important that you protect your stomach pouch by not overeating
Or drinking too much fluid at one time. It's normal for the pouch to stretch somewhat over time,
But frequent stretching will increase stomach capacity and lead to weight gain.
This defeats the purpose of gastric bypass surgery."
Faced with conflicting info from reputable sources, I asked my Doc- "What's Up?"
He's also part of a 'flagship' program and designated a "Center of Excellence."
His response?
"...Not every patient is a University Professor digging for the studies
To back up every detail. 
So, it's easier for some Surgeons to just say-
Don't do ANYTHING that will defeat your success!
Sometimes that's easier
And it's more effective that loading them down with a bunch of statistical data.
If a Surgeon has a patient or two who have to go to the hospital to have gum removed
From their Stomas, he'll begin telling all of his patients- Don't Chew Gum!
Rather than tell them not to swallow their gum or -
"...be careful because I've seen a few cases where patients have had this problem."
So, "Stretching the Pouch" - And - "Stretching the Stoma."
The answer isn't so much do they stretch or even what size are they.
The Real answer is that the FUNCTIONAL size varies with many factors.
Such as-
Time of day, The amount of time taken to eat,
And (most importantly) the type of food eaten.
It is expected and appropriate that the pouch will handle
A much smaller amount of solid food (i.e. chicken) than mushy or liquid stuff like soup.
The "Cottage Cheese Test?"
It is meant to be a standardized, reproducible measurement
Of the physical size of the stomach pouch in a person
Who has undergone a gastric bypass procedure.
If you are curious about your Pouch size, here it is-------
Purchase a container of small curd low-fat cottage cheese.
Begin the test with a full container,
And perform the test in the morning before eating anything else
(this will be your breakfast on that day).
Eat fairly quickly until you feel full (less than five minutes).
Note that the small soft curds do not require much chewing.
The idea with the rapid eating is to fill the pouch
Before there is much time for food to flow out of it.
After eating your "fill" of cottage cheese,
(just to first feeling of full, not to pain.)
You will be left with a partially eaten container that has empty space
Where cottage cheese used to be.
You can measure the remaining amount and calculate the amount.
Dr. Flanagan's Protocol suggested-
"Start with a measured amount of water (16 ounces, for example),
And pour water into the partially empty container of cottage cheese
Until the water is level with the original top level of the product."
Obviously, the amount of water poured into the container,
Equals the FUNCTIONAL SIZE of the pouch.
You will probably find that the "cottage cheese" size of your pouch
Is bigger than your surgeon told you he/she made it at the time of surgery.
But "worry about this causing problem with weight loss?"
Remember the statistics-
17% of RNY patients reach their Ideal Body Weight.
68 % of RNY Patients Lose between 75% to 99% of their excess body weight.
*(That's 85% of All RNY patients reaching a BMI in the NORMAL RANGE!)
10% or 10 in 100 lose an average of 63% of their excess body weight.
*(most of these will be Overweight like the rest of the non-Morbidly Obese People in the country)
5% or 5 in 100 RNY patients lose less than half of their excess body weight.
Further, Most Bariatric Surgeons state that -
"...it is not the pouch size that causes people to regain weight, but that
They never learn how to use their pouch properly. The pouch is misused
By grazing throughout the day, drinking hi-calorie liquids,
Or eating soft easily digestible foods that are high in carbohydrate and fat,
Such as fried potatoes, sweets, breads, and pasta."
Worried that -
"this weight loss tool will stop working and I will resort back to my old self."
Very Common Worry. As common out here as Deep Navels!
5 out of a Hundred may have that problem.
But not due to it becoming "Stretched Out."
Yes?
Continue using this first year to Re-Learn new eating habits
And Food choices, and later on down the line, It will be easier to just
Keep doing what you've gotten in the habit of doing.
That's a pretty effective tool. "Keep doing something Habitually...."
It's how most of us got Obese to start with. Yes?
Forgive my long-winded ramble as an answer.
I just prefer more info than the simple-
"Don't Do ANYTHING that will Defeat your Success!"
One last bit----
"The pouch" is made from the upper most portion of the stomach
The extreme Proximal / Lesser Curvature portion
Comprised of the 'Cardia' and a portion of the 'Fundus.'
Which is the least "Stretchy" and more muscular of the stomach tissue.
Hope this helps-
(hope it's not just a repeat of all the stuff you got by posting on the RNY Board...)
Best Wishes-
Dx
So, it's easier for some Surgeons to just say-
Don't do ANYTHING that will defeat your success!
Sometimes that's easier
And it's more effective that loading them down with a bunch of statistical data.
If a Surgeon has a patient or two who have to go to the hospital to have gum removed
From their Stomas, he'll begin telling all of his patients- Don't Chew Gum!
Rather than tell them not to swallow their gum or -
"...be careful because I've seen a few cases where patients have had this problem."
So, "Stretching the Pouch" - And - "Stretching the Stoma."
The answer isn't so much do they stretch or even what size are they.
The Real answer is that the FUNCTIONAL size varies with many factors.
Such as-
Time of day, The amount of time taken to eat,
And (most importantly) the type of food eaten.
It is expected and appropriate that the pouch will handle
A much smaller amount of solid food (i.e. chicken) than mushy or liquid stuff like soup.
The "Cottage Cheese Test?"
It is meant to be a standardized, reproducible measurement
Of the physical size of the stomach pouch in a person
Who has undergone a gastric bypass procedure.
If you are curious about your Pouch size, here it is-------
Purchase a container of small curd low-fat cottage cheese.
Begin the test with a full container,
And perform the test in the morning before eating anything else
(this will be your breakfast on that day).
Eat fairly quickly until you feel full (less than five minutes).
Note that the small soft curds do not require much chewing.
The idea with the rapid eating is to fill the pouch
Before there is much time for food to flow out of it.
After eating your "fill" of cottage cheese,
(just to first feeling of full, not to pain.)
You will be left with a partially eaten container that has empty space
Where cottage cheese used to be.
You can measure the remaining amount and calculate the amount.
Dr. Flanagan's Protocol suggested-
"Start with a measured amount of water (16 ounces, for example),
And pour water into the partially empty container of cottage cheese
Until the water is level with the original top level of the product."
Obviously, the amount of water poured into the container,
Equals the FUNCTIONAL SIZE of the pouch.
You will probably find that the "cottage cheese" size of your pouch
Is bigger than your surgeon told you he/she made it at the time of surgery.
But "worry about this causing problem with weight loss?"
Remember the statistics-
17% of RNY patients reach their Ideal Body Weight.
68 % of RNY Patients Lose between 75% to 99% of their excess body weight.
*(That's 85% of All RNY patients reaching a BMI in the NORMAL RANGE!)
10% or 10 in 100 lose an average of 63% of their excess body weight.
*(most of these will be Overweight like the rest of the non-Morbidly Obese People in the country)
5% or 5 in 100 RNY patients lose less than half of their excess body weight.
Further, Most Bariatric Surgeons state that -
"...it is not the pouch size that causes people to regain weight, but that
They never learn how to use their pouch properly. The pouch is misused
By grazing throughout the day, drinking hi-calorie liquids,
Or eating soft easily digestible foods that are high in carbohydrate and fat,
Such as fried potatoes, sweets, breads, and pasta."
Worried that -
"this weight loss tool will stop working and I will resort back to my old self."
Very Common Worry. As common out here as Deep Navels!
5 out of a Hundred may have that problem.
But not due to it becoming "Stretched Out."
Yes?
Continue using this first year to Re-Learn new eating habits
And Food choices, and later on down the line, It will be easier to just
Keep doing what you've gotten in the habit of doing.
That's a pretty effective tool. "Keep doing something Habitually...."
It's how most of us got Obese to start with. Yes?
Forgive my long-winded ramble as an answer.
I just prefer more info than the simple-
"Don't Do ANYTHING that will Defeat your Success!"
One last bit----
"The pouch" is made from the upper most portion of the stomach
The extreme Proximal / Lesser Curvature portion
Comprised of the 'Cardia' and a portion of the 'Fundus.'
Which is the least "Stretchy" and more muscular of the stomach tissue.
Hope this helps-
(hope it's not just a repeat of all the stuff you got by posting on the RNY Board...)
Best Wishes-
Dx 
I have no problem with repeating.....
"Copy/Paste" is the easiest feature I can pull off with this computer...
Glad to have you here!!
Best Wishes-
Dx 
Odd how all these docs have differing opinions, huh? Mine seems to have some pretty different opinions with very few prohibitions (including caffeine) but one of the things they do really discourage is carbonation. Can't say I'll never have anything carbonated again but right now am finding I just don't miss it really.
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