For Dieticians/Nutritionists - Sarah, etc.

I have gained 40 lbs since RNY. I am 5 1/2 years post op. Do you recommend low carbing? What do you recommend? I have a deadly sweet tooth. The thought of low carbing scares me but I know that it can be effective. I do not currently work out. I want to know if I should STILL not drink with meals, even this far out. I feel like my pouch has stretched. Basicallly, I need guidance on how to get weight moving quickly again.

Any advice is appreciated!

p.s. I am also very addicted SBUX

Hi Mari -

I'm not Sarah... or even a nutritionist.  But thought I'd jump in anyway. 

My mom is about 5.5 years out and is working to lose about 30 pounds to get back down to her lowest weight again.  She started drinking with her meals and no****ching the carbs and giving in to cookie cravings ... thus the regain.  She's getting back to the basics and making exercise a focus again and now she's slowly losing weight. 

I'm helping her get back on track and this is what I'm recommending to her:

* Protein first always.  Get at least 60-80g protein per day (80-100g is better).  A general rule of thumb is "2 bites of protein, 1 bite of something else" -- and that "something else" should be veggies first, fruit and whole grains second. 

* Use Moderation on Carbs and Make 'em Good.  Low-Carbing it can be dangerous if you don't get enough, so you need to be getting good carbs in your diet that are healthy and help to sustain  your blood sugar levels (not spike them).  Focus on carbs in veggies, fruit, dairy, beans and whole grain starches.  Avoid the "white carbs" like bread, pasta, potatoes, rice and sugar. 

* NO drinking with meals for for 30-90 minutes afterward.  This rule applies for the rest of your life.  Forever and always.  The only time I've heard of a doctor specificaly telling a patient to break this rule is if someone has lost too much weight and is fighting to regain up to a healthy weight again.  To understand why this rule is so important, here's a essay I wrote on my blog: http://pamtremble.blogspot.com/2008/08/why-we-dont-drink-wit h-meals.html

* NO SWEETS!  But then again, you already know this, don't you.  You need to cleanse your body of the sugar rush.... after about 3 or 4 days of avoiding sugar, you won't crave it as much anymore.  Clean out the house and pantry, throw away (or give away) everything that is a temptation and get it out of the house.  And don't buy it again.  Go back to the basics of reading labels and limiting sugar intake to no more than 9g sugar per meal.  If you don't dump, pretend you do.  I don't dump but I still limit my sugar intake as if I do.

* Vitamins are your new religion.  The education given 5.5 years ago was a lot different than what is being given now.  So make sure you are taking the right stuff.  2 multi-vitamins per day (adult ones), 1500-2000mg calcium citrate (not carbonate), one B-50 per day, B12 vitamin and iron.  Here's the current recommendations from the ASMBS for the minimum vitamins you need based on your surgery type.  Then you'll also add more or adjust doses based on your lab results. http://ullberg.us/Andrea/SOARD_Bariatric_Nutrition.pdf

* Labs.  If you ahven't had labs drawn lately, here's the list of what you need done.  Sometimes deficiencies in certain vitamins can contribute to weight regain... so make sure this isn't an issue.  http://pamtremble.blogspot.com/2008/10/labwork-recommendatio ns-after-wls.html

* Exercise your butt off.  Find something you love .... or if you can't love it, find something you can tolerate.  Set some goals and work toward them.  I set a goal to walk a race (5k, 8k, 10k, half marathon, whatever) at least 2 times per month.  My end goal is to do another half marathon in October.  I've joined a 20-week training program where I'll be meeting weekly with a group of other people with the same half-marathon goal... so I'm forced to follow through with my commitment.  Whatever your goal is, find a way to stick to it until you achieve it.  Then set a new goal and work toward that one too.

* Track every morsel of food that passes your lips.  I use www.fitday.com but there are other food log journals out there (DailyPlate, CaloriCount, etc.).  Or if an online journal isn't right for you, get a notebook and pencil and use that.  You can't know what to adjust in your eating if you don't know where you are.  I shoot for 1000-1200 calories per day during the week and about 1400 on weekends.  I keep a balance of 40% protein, 40% carbs and 20% fat with a goal of 30-40g fiber per day. 

* Find a support group.  There are local groups all over.  Find one and get involved.  Studies show that patients who are active in support groups and follow up regularly with their surgeons are more likely to be successful than those who do not get involved. 

* Get involved on OH.  Surrounding yourself with others who are gonig through the same daily struggles will help you be more faithful to your new 'back on track' lifestyle.  I post every morning on the RNY Forum on a thread called "What are you eating/doing today?" -- it  gives me a chance to plan my meals and snacks for the day, chit chat with other WLS friends and get ideas for recipes and meal plans that will keep my food creative and interesting.  Meal planning has really helped me stay on track with food!

Good luck with your quest!  Holler if you need help.

Pam

 Hi!

 First of all, Pam is right on.  I'm glad she chimed in right away as I don't check this a regularly as I used to.  If I had the power, I'd give Pam and honorary R.D. degree.  Sometime I read her posts to educate myself!  Anyway, good work Pam.  

 I agree with Pam, I don't advocate low-carb diets.  The problem I find is that it's a DIET.  I always try to get my GBP clients away from diets and on to a LIFESTYLE CHANGE.  You can only low-carb for so long -- at some point, one is bound to gorge on carbs if they deprive themselves from them for too long.  

 EXERCISE.  Get out there and move your butt.  
 Let me tell you -- I hate exercising.  Absolutely hate it.  I find every excuse not to do it.  But, I drag my butt out of bed 3 mornings each week and go for a run. WHY?  Because exercise is by far the most important aspect of weight loss & weight maintanence.   You can't do it without exercise.  Even if you just park your car in the last spot at work or the mall and walk 5 minutes to get in the building --- then 5 minutes back -- you just gained 10 minutes of exercise for the day.  Start there.  Slowly add a bit more.  Try to exercise at least 20 minutes each day.  You don't have to hit the gym to exercise, you can go for a walk, do gardening, dance ... find something you like and start doing it TODAY!  

 At 5 years out, your pouch likely has stretched and you likely won't dump from eating and drinking at the same time.  Likely.  Of course, I don't know for sure.  It also depending on how the surgeon connected your RNY.  In any event, some people drink while eating because it slows down how quickly they put food in their tummy.  One bit food, one sip water, wait.  One bite food, one sip water, wait ..... and so on.  If you want to drink & eat to slow down your eating during a meal, then I would tell you to go ahead and do it.  However, if you want to drink & eat like all the non-RNY-ers, then I would tell you DON"T DO IT!  Putting too much in your pouch at one time can stretch your pouch even more - causing you to lose any benefit you many have left of the RNY.  

 All in all, I think if you start exercising, you will see that those 40 lbs will come off much easier.  :)  

Good luck!

 Sara

 Oh - and if you are drinking anything at Starbucks that has the word "FRAP" in it -- STOP!  Go for the skinny lattes or something without fat and sugar.  They have a lot of tasty low/no fat and low/no sugar drinks --- get something like that.  I don't think coffee or sbux is the devil -- only if you drink > 2 per day .... if you are doing more than 2 per day -- then ... ai-yi-yi!  Cool it!  

Thank you!!!!!! I appreciate your words of advice! Must appreciated in these tough times