this is a 'must read'....

I found this article. Some of this I did not know and found very interesting. I think it's good to read. Sue Satiety is the feeling of fullness that comes when eating. With that feeling of fullness, you no longer feel hungry and will quit eating. You are very satisfied with the amount of food taken in. For people who have not had surgery, satiety (fullness) is difficult to reach because the stomach continues to stretch and never sends a "full" signal to your brain. Many people, especially those with weight problems, never sense this feeling of fullness except on days like Thanksgiving after having eaten an excessive amount of food. Unfortunately, that probably has helped lead them to the point where they now need the surgery with the excessive weight gain. Questions that we frequently hear before and especially after surgery are: Will the weight loss last? Why do I feel hungry after the surgery? Why am I snacking all day long? Why can I eat a whole plate of food? My weight loss is slowing and/or has stopped, how come? The purpose of the gastric bypass is to decrease the effective size of the stomach reservoir. This is done by surgically reducing the stomach to a small pouch, approximating the size of a shot glass. The small intestine is then attached, permitting the pouch contents to reach the rest of the GI tract. At the time of surgery this connection can be made small, medium or large, depending on the surgical technique of the surgeon doing it. All three sizes will stricture down to a smaller size during the healing phase, making the final size much smaller than when it was originally created. If you have an opening (anastomoses) that is created very small, around 2 cm, this can stricture to a point where approximately 20 percent of these patients will require a balloon stretching to get anything at all to go through. More importantly, though, is that all these openings will dilate in time to some degree. Once the healing has occurred, the scar tissue starts to resolve and a gradual stretching does develop. When you look at most of these openings two, three and four years out, they all look pretty much the same. The big question is, why doesn't everyone regain all their weight back if there is no stricture of that area? The answer: Weight = calorie intake (volume and type) - calorie input Some basic principles with bariatric surgery include the following: Surgery is only for calorie intake control. It does not cause your body to burn fat and has nothing to do with calorie output. The purpose of bariatric surgery is to create a penalty for eating incorrectly. Eating too much or the wrong types of foods in the beginning will make you feel ill. There is no operation that we devise that you cannot find a way to beat. You can change your eating style, change your eating choices, or lastly, retrain your intestinal tract to tolerate the poor choices that you can make. The answer for making this pouch work for you for the long term is in food choice and in proper use of the pouch. Any incorrect food choices will defeat the surgery and lead to increased calorie intake. An earlier version of bariatric surgery was a vertical banded gastroplasty where the outlet opening actually was permanently controlled by the use of a plastic screen. This opening never stretched with time and yet almost eighty percent of this group of people would gradually regain their weight over a five-year period. They were able to accomplish that by consuming liquids, soft or mushy food which easily went through any kind of opening that they had. This course allows them to override the restriction they were given and the same thing can happen to the gastric bypass. Picture your pouch as a funnel; (the same type you have in your kitchen). You can pour any liquid, whether it's regular soda, orange juice or soup into this funnel and it runs right straight through. That also occurs with your pouch. You can take in an unlimited amount of calories if it is in a liquid, soft or mushy form. There is no restriction and it does not matter how tight the opening is-- it always will go through. The way your pouch works is by having pressure applied to the wall of the pouch. This pressure sends a signal to your brain that says, "You are now full." The brain has no way to interpret if it is a cup of food or three plates of food; it does not care, as long as it gets the proper signal. By putting the proper type of food into the pouch that creates pressure, you then sense the full feeling, the brain receives the signal, and satiety is thus achieved. A classic complaint I hear from some patients is that they are unable to eat rice because it makes them hurt all the time and then they throw up. To me, what I am hearing is that "I ate too fast without stopping when the pouch started to feel slightly full and then became uncomfortable and threw up." It has nothing to do with the rice; it has everything to do with how much and how fast it was eaten. You have to slow down so the brain has a chance to get the signal before you get to the point of throwing up. By selecting proper food choices, i.e. foods that do not just run through a funnel, it will sit in that pouch longer, waiting for the body to slowly digest the material into the soft, mushy substance that will pass through. It usually takes about an hour. You will remain full and satisfied during that period of time, which leaves you even closer to the next meal and does not give you time between meals to feel like you need to snack because of an empty feeling. Even if your anastomosis stretches somewhat with the passage of time, this principle will always work for you and keeps on working for the rest of your life. You want to make sure you have that full feeling with each meal and to have it last after a meal, you have to make proper food selection. In other words, chicken, fish, vegetables, and avoiding anything that will make this mixture very soft and mushy, such as soups, puddings and even liquids taken at mealtime. In taking a bite of food, people feel they have to drink a little bit of liquid to get it down. That is done because they take too big of a bite, chew it poorly and just swallow. If you take a small enough bite and chew it adequately, it has no problem with passing. Adding liquids only adds to the more rapid passage of food out of the pouch which then defeats the whole principle. I tell my patients not to put a glass of anything at the table, and do not drink for at least one hour after meals. If food passes with some difficulty, change the way you are eating to avoid discomfort. In following these principles, you will find that you eat far less food, you will stay full longer, and the satiety will last longer after a meal, which is what you are looking for. Other foods that can be added to any meal three times a day that would help this process of feeling satiety include undercooked rice (less water than what is called for when cooking) and slightly undercooked pasta. A couple of bites of these, along with your chicken and vegetable, will do wonders giving that full feeling for even a longer period of time with less total calories. The principles to remember include the following: No liquid intake one half hour before, during or an hour after a meal. Allow the full feeling to last as long as possible and you will have a dramatic decrease in total calorie intake. Your food choices have to be well thought out. Whatever goes through a funnel rapidly is usually a wrong choice. Any kinds of soups or mushy type foods are improper. If you happen to get some hunger feelings between meals, drink a glass of water as rapidly as you can. The rapid intake causes a stretching of the pouch, which will temporarily send a signal to your brain that you are now full and you no longer have that hungry feeling. This is usually enough to get you by until the next meal. There is no snacking between meals. If you feel hungry, and you think you have to snack, you need to ask yourself two questions: Am I snacking because of poor food choices and improper eating habits or do I have psychological issues that need to be addressed? In summary, the size of the opening is not going to affect your eventual weight loss satisfaction and control over the long term. Food selection and staying away from liquids at mealtime or for an hour afterwards does affect it. It is to your advantage to make these lifestyle changes. Try it . . . you will like it. Dr. Betcher is the founder and Medical Director of Tempus Surgical Weight Reduction. http://www.tempuswls.com CLICK HERE TO SUBSCRIBE

you're right. that was very interesting. alot of that stuff i didn't know. my dr told me to not drink anything, 1/2 before and after, and during the meal. but no snacks in-between? that's gonna be a hard one. were you told to only sip your water? i was. so how can i quickly drink it. maybe i'll try and see what happens. thanks for that article. sue

hi Sue, I ,too, was told 5 meals a day-small ones, but 5. And I also was told 1/2 hr before and after meals not to drink. But I tell you what, I tried this out today (the pasta/rice thing, too) And I wasn't nearly as hungry. I think over time I just started to compremise TO MUCH. Going back to the basics IS helping. (taking my time to eat, timeing the 'no drink' time, smaller portions....) I was eating a lot of softer foods, like cottage cheese, soups and joghurt. But I guess I'll have to cut down on those and start eating the more filling things like fish, chicken and some rice. What I found very interesting in this article was that no matter what you do the poutch will stretch and that in 2,3 years all poutches look alike- no matter what size they were made in the beginning. I wasn't told that! Oh, about the just sipping you water... That is true for the very beginning, but a few weeks out you can drink more. A couple of weeks after my surgery, I always felt so thirsty, cause I was scared to drink to much at one time,but my doctor told me, that excess water will just drain out and it won't harm you. Sue

I always hear so many different answers to your statement... "What I found very interesting in this article was that no matter what you do the poutch will stretch and that in 2,3 years all poutches look alike- no matter what size they were made in the beginning." From what I understand is that now they make our pouches from an area of the stomach that reduces stretching. They are doing so many testings now on wls that hopefully they will have a better understanding in a few years. ~Kristin

I just wanted to tell you how beautiful you are. I'm in the process of getting this surgery and like to look at profiles and such of people. You really did blossom like a butterfly. Your husband sounds like a great guy also. Keep it up and congrats!

Kelly, You are extremely sweet, you have touched my heart. Thank you for your kind words. I could not have come this far without the help of my loving husband (who this week is the best As he says from hero to zero in 2 seconds lol) and my wls family. I wish you all the luck in this world on your wls journey. Keep us posted on your progress ~Kristin