Guidelines for Newbies

According to the book, Ms. Cook writes that per Dr. Charles Edwards, there are 3 reasons to avoid carbonated beverages. "1. Distention of the stomach pouch and anastamosis - when a cold, carbonated beverage is consumed, it warms and releases gases, distending the stomach pouch. This stretching of the stomach then creates undue stress and, subsequently, may cause stretching of the anastamosis. It is important for this "outlet" to stay small and tight in order for the food to empty slowly from the stomach pouch. If it is stretched, the ability to feel full is compromised and overeating is usually the result. 2. Caloric intake - many carbonated beverages are high in calories, low in nutrional value and contain simple sugars. Not only do they add additional calories with low nutritional value, they are absorbed quickly into the blood stream, sometimes causing a rapid rise in blood sugar, elevated insulin levels, and increased hunger. 3. Caffeine - many carbonated beverages contain caffeine, which many believe to be an appetite stimulant, which is detrimental to initial weight loss and long-term weight maintenance." Amy, although some patients may be able to drink carbonated beverages and keep their weight stable, many may also be able to achieve this without doing any regular exercise. I'm sure you would agree that it's better to exercise! There are also reasons why giving up carbonated beverages is better. What if you're wrong? What if soda DOES stretch the pouch? The outcome of the surgery could then potentially be harmed. But on the other hand, what if I'M wrong? Then I've given up soda for no reason, but no harm has come to me. As for eating and drinking at the same time, Ms. Cook writes: "The name of the game is to feel full and satisfied on very little food, then you don't want to eat and drink at the same time or drink right after you eat, as it will flush the food through your system too quickly. The consequence: you feel hungry again sooner than you should. And many eat again too soon, resulting in greater calorie consumption than is actually needed and - you guessed it - weight gain." She goes on to say "Several years ago, a patient out four months from surgery came in to one of our classes and exlaimed, 'I don't think they even did anything in there. I can eat four cheese sandwiches all at once!' .... After some initial discussion we discovered how and why this was happening. She was eating a little and drinking a little, eating then drinking, eating then drinking. She was constantly forcing food through the anastamosis into the intestine, then she felt hungry again right away ... Although this is a simple concept, you can see how easily this tool can be compromised." Again I ask, what if you're wrong and fluid can push food through too quickly? Then the risk is there to overeat. If I am wrong, I get a little thirsty while eating. In the book, Ms. Cook states that in her study of successful weight-loss surgery patients, the successful ones all had these Success Habits in common. Some may be able to achieve success with only 5 out of 6 Success Habits, but if you follow all of the Habits, success is pretty much in the bag. I appreciate your opinion and your post, Amy!!! Jan

Thanks Jan, I've actually got a copy of this book. Dr. Edwards is quoted in there, but he doesn't give reference to any scientific study that demonstrates his theory is true. I've yet to see that. I'm not really sure how the basis of his input is actually medically supported. The portion that Colleen is quoted as above same as what I've wrote above, there is nothing study wise to back up her claim that eating and drinking will wash the food out. I see she does talk about a situation with a member in a support group, but that's not really good conclusive evidence that the theory is in fact correct. They really need to do some good case studies to support some of these findings, this is something we all really should know is fact. It's hard to write a handbook on this surgery because each surgeon's opinion is so different, just visit an ASBS conference (American Society of Bariatric Surgeons) Amy

2) Portion Control - Achieve and maintain satiety (eat enough at each meal to avoid snacking, don't drink while eating and thereby emptying the pouch too soon, protein first always), Avoid grazing snacks are an integral part of my plan, 3 meals 3 snacks a day AKA 6 small meals. we are all individual, I cannot meet my bodies needs on 3 meals a day nutrtionally or calorie wise. I need 1600-1700 calories a day to maintain my weight and feel good and exercise inthe manner to which I have become accustomed. 3) Nutrition - Protein first (70% of intake), Value of veggies (30% of intake), Understand carbs (good vs. bad), Fat in the diet I have been told to follow a diet with ALL the food groups including dairy and whole grains. Calorie ratios = 40% cals from carbs, 30% protein and 30% fats. This is a diet for an active athletic person who exercises regularly. 4) Fluid Intake - Do not drink with meals, Avoid caffeine, Avoid alcohol, 64 oz. of water daily, Carbonated beverages WILL expand the pouch and the stoma to allow more food and result in weight gain the carbonation thing is a bunch of BS in my honest opinion. It might be true if my pouch were a ziplock back, but siunce I burp AND fart I'm not worried that it will stretch my pouch. ( altho I rarely indulge as I dont care for the taste of most diet sodas, not because of some silly theory that they will stretch my pouch) I avoid caffeine because I don't sleep well if I indulge, that was true preop too. but honestly cannot believe it has any really harmful effects. I don't drink because I am on wellbutrin, and it IS empy calories and I'd rather have something substantial in my belly, but I think an occasional drink is fine. 5) Regular Exercise - Achieve your target heart rate, Exercise regularly doing both aerobic and strength training (weights) ABSOLUTLEY KEY TO MAINTAINENCE!!!! In my fitness program 3 components are KEY, strength training, as in weight lifting, push ups etc, for muscle developement and bone density, cardio - to maintain a healthy heart, and build endurance, and flexibility training as in Yoga and stretching. 6) Vitamins and Supplements - Vitamins needed daily to include enough Thiamin, calcium and B12, Liquid vitamins are absorbed easiest, followed by chewable or capsules and finally pill form. everybody is an individual., and may have differing needs. I have to take iron as well, swear by citracal, & liquid B-12 from gnc, but take regular vitamins otherwise.

When I said snacking, I meant mindless snacking, not planned snacks as small meals as you have them. Sorry I was unclear. As for your nutrition, do you get in at least 60 grams of protein if you eat in that ratio? Just asking for clarification. I'm glad to hear you burb (((GRIN))), but what if you didn't? When I was Pre-op, a soda would REALLY fill me up and I have to assume that was because of the carbonation! Read also my response to Amy. What if you're wrong and/or what if I'm wrong about soda? If you're wrong, there could possibly be some harm done, but there's no harm done if I'm wrong. I'd rather err on the side of caution and the book says also that the Success Habits are found in successful patients, but that's not to say that some people might succeed if they follow 5 out of 6 habits. I think an occasional drink is also fine. The book doesn't say "never" drink alcohol, but it says "avoid" and be careful. You agree with the exercise thing, but some people would argue that they lost all their weight and kept it off while not exercising at all. Again, the book says that successful patients followed the 6 Success Habits, but it's still possible to achieve good results while following 5 out of 6. You just are more inclined to be successful if you follow them all. Are any of the suggestions harmful? As for vitamins, I simply forgot to include iron, but of course, you're right about that!! Oops! Thanks so much for your thoughtful post and comments!!! I appreciate it so much! Jan

my recommended protein intake is 56 grams a day and I usually get at least 70-90 with out a problem. My wordy reply was really meant to say, we are all individual and I don't think you will ever find a list of rules that everybody will agree on or support. all docs seem to have their own protocols. there is little eveidence based practice in the care and feeding of Bariatric surgery patients and I think the docs are just making it up as they go. being a nurse working in a hospital I am over the doctor always has the answer. Most of them have little to no nutritional training. more and more of them are just as obese as the general population (60% + of americans are over weight or obese)

I also work in healthcare and I'm over doctors as well!! (((grin))) I think these Success Habits are good, basic guidelines. There just seems to be soooo very many newbies that could use more guidance because some doctors seem to have no protocols or education for their patients. I'm still looking (grasping) for a way to help them. My heart is in the right place, even if my brain isn't!! Jan

In my opinion, there only 2 rules... 1) Do what your surgeon says; 2) Ask your surgeon; We could add a 3rd... 3) Ignore what strangers on the internet believe. The stronger they believe it, the more likely it is to be wrong. I believe this very strongly. Tek

Don't forget, my post was actually little more than a book review!! I agree with following what my surgeon says, I agree that people should ask my surgeon. Do you want his number so you can ask him???? As for "the stronger they believe it, the more likely it is to be wrong", well, I strongly believe your intention is to be helpful and I really, really believe you're funny and a nice person!!!!!!! I LOVE your posts, Tek!!!!! Jan

Its been ages since I was slammed so cleverly... Thank you Tek

I wanted to be clever - that was my goal. I wasn't slamming you!! Want the truth? I wanted to make you laugh and thought you'd appreciate the post, as you have a very dry wit!! Did I succeed????? Jan